Jibiki Masatoshi, Miyata Tetsuro, Futatsugi Sachiko, Iso Mitsumasa, Sakanushi Yasutaka
Department of Vascular Surgery, International University of Health and Welfare, Shioya Hospital.
Department of Vascular Surgery, International University of Health and Welfare, Shioya Hospital; Department of Vascular Center, Sanno Medical Center.
Laser Ther. 2016 Oct 1;25(3):171-177. doi: 10.5978/islsm.16-OR-12.
In Japan, stripping under general anesthesia, lumbar anesthesia and tumescent local anesthesia has been used in the treatment of primary varicose veins due to saphenous vein insufficiency. However endovenous laser ablation (EVLA) using a 980 nm diode laser has received National Health Insurance (NHI) coverage in 2011, while EVLA using a 1470 nm diode laser with a radial 2-ring fiber has received coverage in 2014. As a result, the use of EVLA has become widespread in Japan. We herein report on the results of varicose veins treatment at our hospital. Two hundred eighty-nine patients with saphenous vein reflux who received treatment between October 2013 and December 2015 were included in the present study. The surgical results (operating time, complications, ablation rate, linear endovenous energy density [LEED], and the incidence of surgical site infections [SSI]) were retrospectively assessed and compared among the patients who underwent stripping (group A) and those who underwent EVLA (group B) according to the Japan Guidelines for EVLA. Group A and group B included 49 patients and 240 patients, respectively. Group B comprised 20 patients who underwent EVLA using a 980 nm laser (group B1) and 240 patients who underwent EVLA using a 1470 nm laser (group B2). The operative time in group A was 48 ± 16 minutes, whereas that in group B was 28 ± 10 minutes. The operative time, the length of the treated vein and LEED in groups B1 and B2 were 40 ± 11 and 27 ± 10 minutes, 36 ± 10 and 33 ± 10 cm and 84 ± 10 and 77 ± 18 J/cm, respectively. Furthermore, the mean operative time in group B1 (with no phlebectomy) was 31 ± 9 minutes, whereas that in group B2 (with no phlebectomy) was 22 ±7 minutes, which was statistically significant (<0.05). The level of pain peak was day 1 in group A patients and on days 3-7 in group B1 patients; the group B2 patients felt little pain. Surgical site infection at the phlebectomy site was observed in two group B2 patients. EVLA resulted in an occlusion rate of 99.6% at approximately two years after surgery. This study showed that EVLA using the 1470-nm laser caused less pain and bruising than EVLA using the 980-nm laser. The operative time of EVLA was approximately 9 minutes shorter than that of stripping. Therefore, EVLA using the 1470-nm laser might be the first treatment of choice for patients with saphenous vein reflux. However conventional surgery remains important because EVLA is not suitable in cases in which the diameter of the saphenous veins is >20 mm or in patients with highly tortuous veins.
在日本，全身麻醉下剥脱术、腰麻和肿胀局麻已被用于治疗因大隐静脉功能不全引起的原发性静脉曲张。然而，使用980纳米二极管激光的腔内激光消融术（EVLA）于2011年被纳入国民健康保险（NHI）覆盖范围，而使用带有径向双环光纤的1470纳米二极管激光的EVLA于2014年获得覆盖。结果，EVLA在日本已广泛应用。我们在此报告我院静脉曲张治疗的结果。本研究纳入了2013年10月至2015年12月期间接受治疗的289例大隐静脉反流患者。根据日本EVLA指南，对接受剥脱术的患者（A组）和接受EVLA的患者（B组）的手术结果（手术时间、并发症、消融率、线性腔内能量密度[LEED]和手术部位感染[SSI]发生率）进行回顾性评估和比较。A组和B组分别包括49例和240例患者。B组包括20例接受980纳米激光EVLA的患者（B1组）和240例接受1470纳米激光EVLA的患者（B2组）。A组的手术时间为48±16分钟，而B组为28±10分钟。B1组和B2组的手术时间、治疗静脉长度和LEED分别为40±11和27±10分钟、36±10和33±10厘米以及84±10和77±18焦耳/厘米。此外，B1组（未行静脉切除术）的平均手术时间为31±9分钟，而B2组（未行静脉切除术）为22±7分钟，差异具有统计学意义（<0.05）。A组患者疼痛峰值出现在第1天，B1组患者出现在第3 - 7天；B2组患者几乎没有疼痛。在两名B2组患者中观察到静脉切除部位的手术部位感染。EVLA在术后约两年的闭塞率为99.6%。本研究表明，与使用980纳米激光的EVLA相比，使用1470纳米激光的EVLA引起的疼痛和瘀伤更少。EVLA的手术时间比剥脱术短约9分钟。因此，对于大隐静脉反流患者，使用1470纳米激光的EVLA可能是首选的治疗方法。然而，传统手术仍然很重要，因为当大隐静脉直径>20毫米或静脉高度迂曲时，EVLA并不适用。
