Experience of minimally invasive electrocoagulation treatment of varicose veins in 158 casesDong Yi Li Bin(Department of general surgery the
Experience of minimally invasive electrocoagulation treatment of varicose veins in 158 cases
Dong Yi Li Bin
(Department of general surgery the Affiliated Xinhua Hospital of Dalian University two 116021)
[Abstract] Objective To summarize the experience of clinical application of minimally invasive electrocoagulation for varicose vein. A total of 158 cases of minimally invasive electrocoagulation treatment of varicose veins by ~2006 in August 2003 August, after the venography and venous ultrasonography (CDFI) confirmed deep venous valve function is less than the third level, using self-made electric coagulation and electrocoagulation needle catheter tube electrocoagulation closure of varicose vein surgery using elastic bandage, intravenous drug application of removing blood stasis. Results no recurrence was found in 156 limbs. There were 2 cases with local recurrence. Conclusion minimally invasive electrocoagulation treatment of varicose veins has the characteristics of simple, beautiful appearance, small trauma, faster postoperative recovery, is worthy of clinical application.
[Key words] saphenous vein; varicose vein; minimally invasive electrocoagulation
Treament of Great Saphenous with report of 158 Electorcoagulation.A cases. Varicose
Dong Yi, Li Bin (DaLian Univercity Xin Hua Hospital, Dalian, China116021), Afiliated
[Abstract] ObjectiveTo value the clinical effects of varicosity of lower limbs treated by electrocoagulation.Methods158 cases were elected by lower limb venography and CDFI, Electrocoagulation canula inserted into the great saphenous vein from ovum or above ankle.The branches of great sapyenous vein wewe severed and electrocoagulated by canula respectively.Results were all cured 156 cases and 2 cases relapse part within 2~12months. ConclusionThis easy and reasonable minimally invasive operative technique is worth recommending.
[Key words] Varicose veins; Great saphenous vein; Electrocoagulation
Varicosis of great saphenous vein is a common disease of vein, operation methods, using a minimally invasive approach in treatment of varicose veins is gradually applied to clinical . In our hospital from August 2003 to August 2006 to use minimally invasive electrocoagulation treatment of varicosis of great saphenous vein in 158 cases, a total of 158 limbs, obtain satisfactory curative effect, report as follows now.
1 materials and methods
1.1 general information
In this group, 116 cases were male, with a total of 116 limbs, and a total of 42 female patients, with a total of 42 limbs. The age of the patients was 26~78 years old. The duration of the disease was from 3 months to 12 years. There were 131 cases of preoperative Anterograde Venography, the remaining 27 cases due to contrast agent allergy and other reasons for lower extremity venous ultrasound (CDFI) examination, 158 limbs were found with deep venous thrombosis; deep venous valve function, level 0: 36 limbs, 82 limbs: Grade I. Grade II: 40 limbs. The 158 limbs, accompanied by blood stasis dermatitis 36, foot boot area pigmentation of the 142, preoperative patients with superficial phlebitis, accompanied by superficial venous thrombosis of the 9 article of the 12. The patients with skin rupture were not included in this group.
1.2 surgical methods
The inguinal ligament femoral artery pulsatility medial oblique incision, about 3cm, and separation from the fossa ovalis 0.5cm high ligation of great saphenous vein, saphenous vein branch ligation all incision range can be detected, since the distal saphenous vein into the self-made coagulator to the medial malleolus on casing. If the resistance can not be thorough, in-depth casing electrocoagulator guidelines are in great saphenous vein puncture in the medial malleolus guide wire, with 20 ~ 25W electric coagulation under the main vein, each branch varicose vein with 16 15W casing electric coagulation needle electric coagulation, electrocoagulation side edge compression, after lower limb wound a sterile elastic bandage to the upper thigh, and then to 30~35w electric coagulation upper saphenous vein ligation, hemostasis, inguinal incision with 3-0 absorbable suture.
1.3 postoperative treatment
Postoperative limb elevation 30. Foot function exercise and lower limb massage to prevent deep vein thrombosis, 6h can be separated from the bed activity. At the same time, safflower and Xuesaitong and low molecular dextran and other blood cured poly drugs, and antibiotics to prevent infection.
After the operation of varicose veins disappeared, no infection or deep venous thrombosis, part of patients with lower extremity 3~7d subcutaneous congestion, total absorption. All the cases were followed up for 2 months ~1 years, 2 patients in 6 months when the single leg vein prominent in 0.3cm incision under local anesthesia to cut vein stripping and cure.
Varicosis of great saphenous vein is a common venous disease, surgery is the only treatment completely solve the disease, surgical methods, traditional treatment methods are of great saphenous vein ligation and stripping of surgical trauma, incision, postoperative complications, slow healing, directly affect the local appearance. In recent years, minimally invasive treatment has been gradually applied to clinical, because of its small trauma, rapid postoperative recovery, low recurrence rate, local beauty without scar, has been widely accepted by patients . Our department since the beginning of 2003 the use of minimally invasive electrocoagulation treatment of varicose veins, achieved satisfactory results. Compared with the traditional surgical method, it has the following characteristics:
(1) surgical trauma, cut small saphenous vein ligation and its branches, and the use of absorbable suture incision in the thigh, after surgery without clearing. No incision infection occurred in 158 cases.
(2) postoperative recovery was rapid, and 4~6h could get out of bed after anesthesia recovery, and the incidence of postoperative deep venous thrombosis was avoided.
(3) postoperative lower extremity appearance, leg exposed parts without incision, no scar formation, occasionally subcutaneous bleeding, there were 22 cases, basic absorption 3~7d, meet the requirements of the body.
(4) the recurrence rate is low, the 156 patients were followed up so far found no recurrence, single leg vein in 2 cases of patients at 6 months, and the cure stripping under local anesthesia and surgery in blood vessels, electric coagulation is not perfect or postoperative elastic bandage is not perfect.
In the implementation of the operation, some problems should be noticed, such as postoperative lower limb or ankle swelling, subcutaneous bleeding and coagulation necrosis of skin burns, our experience is:
(1) routine antegrade venography of the lower extremity is performed before surgery. For patients with deep venous valve function III, the use of this procedure should be performed in the treatment of deep venous valve repair due to unresolved blood flow problems. In addition, some patients with deep venous thrombosis who had no obvious clinical symptoms were found to avoid the swelling caused by venous reflux disorder.
(2) although no incision is our pursuit, but we should not only for the pursuit of beauty and the remaining portion of the varicose vein for electrocoagulator can not reach the place or electric coagulation is not perfect, we adopt cut small (about 0.3cm) stripping and ligation of varicose veins using mosquito forceps, prevent postoperative recurrence the incision, no suture, scab after scar, can meet the aesthetic requirements.
(3) surgery since the oval fossa is inserted into the electric condenser, sometimes because the barrier can deep vein valve, when not to use violence to prevent insertion, perforation of blood vessels is not up to the treatment effect, to anatomize the great saphenous vein from the medial malleolus, antegrade insertion to the fossa ovalis electrocoagulator which can be better to solve this problem. In this group, 53 cases were treated with this method, and there was no significant difference between the two groups.
(4) when the operation should reserve 2 to 3 different thickness of the electrocoagulator, according to the lumen size of great saphenous vein selection, electrocoagulator is made of 1m steel, coated insulating tube, the tip exposed 0.5cm, in order to control the discharge range.
(5) early postoperative functional exercise to prevent the formation of deep venous thrombosis.
(6) after the completion of the elastic bandage is the key, so that after the coagulation of vascular closure.
(7) the early use of blood circulation drugs after surgery, such as Xuesaitong injection, Honghua injection and low molecular dextran.
Minimally invasive electrocoagulation treatment of varicose veins has the characteristics of small trauma, beautiful appearance, simple and rapid postoperative recovery, is worthy of wide clinical application.
1 Lian Feng, Dong Guoxiang. Clinical experience of electrocoagulation in the treatment of 92 cases of varicose veins of lower extremity. Medical industry information.2005, (15): 41 ~ 42
2 Wu Danming, Dong Qi, Yi Wei et al. Clinical analysis of electrocoagulation in the treatment of varicose veins of lower extremity. Chinese Journal of practical surgery.2002, 2 (22): 99 ~ 100