摘要目的 探索传统手术和硬化剂在治疗下肢静脉曲张中的最佳组合术式.方法 设计手术联合硬化剂治疗静脉曲张的方案:大隐静脉主干高位结扎,膝上段剥脱或激光闭合、膝下段硬化剂注射,穿通支静脉结扎,曲张静脉硬化剂注射,2015年4-6月采用该方案治疗下肢静脉曲张31例(31条下肢),其中7例为术后复发者.临床分级:C2:9例,C3:4例,C4:17例,C6:1例.术前彩超定位穿通支静脉.结果 穿通支静脉数量以小腿内后侧为主(4.16±1.86),小腿外侧和大腿段分别为1.29±1.10和0.16 ±0.45,3组间差异有统计学意义(P＜0.01).24例行大隐静脉高位结扎加剥脱膝上主干,2例行大隐静脉高位结扎加激光闭合膝上主干,5例未处理(4例已剥脱或闭合,1例正常);膝下大隐静脉27例采用泡沫硬化剂注射,4例未处理(3例闭合,1例正常);31例均小切口结扎穿通支静脉,均采用泡沫硬化剂闭合曲张静脉.患者术后2～3d出院时,硬化剂处理的膝下大隐静脉均硬变.20例曲张静脉呈皮下硬结,轻微压痛,11例闭合良好,无不适.全组无深静脉血栓形成,无肺栓塞和视觉障碍等并发症.结论 手术联合硬化剂治疗大隐静脉曲张近期效果良好.

abstractsObjective To evaluate combination of traditional surgery and sclerotherapy in treating varicose veins of the lower extremity.Method This protocol includes high ligation of the great saphenous vein (GSV),stripping or laser closing of GSV above knee,injection of sclerosing agent into GSV below knee;ligating the perforator veins;sclerosing agent injection for varicose vein in 31 cases of varicose vein of the lower extremitis,among them seven were recurrent cases from April 2015 to June 2015.The clinical classification was as follows:nine cases of C2,four cases of C3,seventeen cases of C4,and one case of C6.All the perforator veins were located before the operation by color ultrasound.Results The number of perforator veins varied significantly (P ＜0.01) among the inner and back side of calfs (4.16 ± 1.86),the lateral calfs (1.29 ± 1.10),and thighs (0.16 ± 0.45).Twenty-four patients received high ligation of GSV combined with stripping of above-knees.Two patients received high ligation of GSV combined with the laser closing of above-knees.Five cases were treated conservatively (in which four have stripped or closed and one was on normal condition).Below-knee GSV were treated by sclerosing foam in 27 cases,and four cases were untreated (in which three have closed and one was normal).All the thirty-one cases underwent mini-incision for ligating the perforators and having the varicose veins closed using the sclerosing foam.All patients' GSV with sclerotherapy have got sclerosed.There were no complications of deep vein thrombosis,pulmonary embolism,or visual disturbance.Conclusion This operation design ensures the effect and prevents the recurrence of varicose vein,as well as reduces surgical trauma.