摘要
目的探讨彩色多普勒超声在经皮高位连续环形缝扎大隐静脉手术中的应用价值。方法利用彩色多普勒超声选择单纯性大隐静脉曲张患者30例,术前应用彩色多普勒超声对隐股静脉连接部附近的股总静脉进行体表投影定位及体表距离测量,对内踝以上的大隐静脉的走行进行全程皮肤定位,对功能不全的交通静脉在穿过深筋膜处进行皮肤定位。连续硬膜外麻醉在彩色多普勒超声监测指导下利用自行设计制造的双尖缝合针对隐股连接部进行经皮连续环形缝扎,对其余主干及曲张团块也进行同样的缝扎。结果 30例患者均一次手术成功,术后3天复查超声示大隐静脉呈节段性闭塞并伴有周围组织纹理走行勒扎变形,大隐静脉内偶有少量血液但不流动。术后2月、6月复查彩色多普勒超声示大隐静脉内无血流闭塞,其周组织纹理走行也恢复正常。结论在超声引导下应用双尖缝合针对大隐静脉进行经皮高位连续环形缝扎治疗的方法安全可靠、简便省时、并发症少、没有疤痕、微创美容。应用彩色多普勒超声对手术部位的精准定位与测量可为手术指明方向,术中实时监测是手术成功和并发症防范的重要保证,也是术后定期复查评价手术效果的常规手段。
Objective To discuss the applicational value of color Doppler ultrasound during great saphenous varicose operation with percutaneous high continuous circumsuture. Methods 30 patients suffering from simple great saphenous varicose were chosen under color Doppler ultrasound. The body surface projection and the surface distance of common femeral veins near the saphenofemoral junction are marked under ultrasound guidance, the body surface projection of whole great saphenous running above medial malleolus and the starting part of the perforating veins in subcutaneous tissue are marked under ultrasound guidance. The operated modus of percutaneous continuous high circumsuture of saphe- nofemoral junction with homemade double-tipped needle by ultrasound guidance were adopted,the rest and other varicose veins were performed by the same way. Results 30 patients （42 limbs） were treated successfully. During the operation, one case developed a subcutaneous hematoma from a little artery at operation area confirmed by color Doppler ultrasound, the hematoma stopped developing after being compressed for ten mimutes. On the first day after operation, another case is performed second same operation because of loosed suture causing the great saphenous recanalization which is confirmed by color Doppler ultrasound. On the third day after operation color Doppler ultrasound examination showed that all operated great saphenouses were segmental closed together with changes of the shape of bundled subcutaneous tissue around the vessels,there is a small amount of residual blood which does not flow in some of vessels. At 2-month and 6-month fol- low-up,color Doppler ultrasound examination showed that all great saphenouses were closed without blood stream and changed subcutaneous tissue returns to normal. Conclusion The operating therapy of pereutaneous continuous high circumsuture with double-tipped needle by ultrasound guidance is a safe and reliable method which have many advantages such as convenience, saving time, fewer complications, no scar, minimal invasion and cosmetic effect.
出处
《西部医学》
2015年第4期520-522,525,共4页
Medical Journal of West China
关键词
大隐静脉曲张
彩色多普勒超声
双尖缝合针
经皮浅静脉连续环形缝扎术
Greatsaphenous varicose
Double-tipped needle
Percutaneous continous high circumsuture
Minimalinvasion
Saphenofemoral junction
