RU2281039C1 - Method for surgical therapy of varicosis of inferior limbs - Google Patents

Abstract

FIELD: medicine, phlebology.

SUBSTANCE: one should cross a large subcutaneous vein in the site of its inflow into femoral vein and its isolation near internal ankle. Removal of veins should be carried out after endovasal fragmental electrocoagulation. Moreover, one should apply a needle with a ligature subvenously to withdraw it diametrically opposite outwards. Then through the foramen of puncture out one should apply a needle with a ligature supravenously to withdraw it outwards through the puncture in. Venous fragment should be tightened up with a ligature to remove it. After that, similarly, one should remove successively by fragments varicosed and lateral venous inflows observed at tightening the ligature and communicant veins in area of varicosis. Moreover, one should apply a pressing bandage immediately onto the removed part. The innovation enables to decrease traumatism of operation and chance for post-operational relapses, increase cosmetic result due to removing veins through small-sized puncture foramens.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to phlebology, and can be used in the surgical treatment of varicose veins of the lower extremities.

There is a known method of venectomy (RF Patent No. 2217070, IPC A 61 B 17/00, publ. 2003), in which cuts are made over the tributaries of the entire varicose vein, a needle with a ligature is drawn between the cuts, a ligature is wound into a ligature in the form of a bundle vein and extract it.

The disadvantage of this method is its high invasiveness, the presence of foreign bodies after surgery in the cellular space.

A known method of surgical treatment of varicose veins, in which perpendicular to the saphenous vein along its course punctures the skin through 2-3 cm with a special hook that captures the vein, is removed through a puncture to the skin with its subsequent ligation (RF Patent No. 2072234, IPC A 61 B 17/00, publ. 1997).

The disadvantage of this method is the presence of a closed wound channel with one drainage hole, which can lead to suppuration, the passage of the hook through the tissues is not controlled, it is possible to capture the fascia and muscles left after the ligature operation lead to the growth of connective tissue in this area and painful effect.

The closest is a method of surgical treatment of varicose veins of the lower extremities, including the removal of a large saphenous vein on the thigh and lower leg, varicose veins and associated communicating veins (RF Patent No. 2125409, IPC A 61 B 17/00, published in 1999) .

The disadvantages of this method include large scars in the area of the postoperative wound on the posterior surface of the lower leg, often prone to suppuration and discrepancy. Opening the fascia of the tibia often leads to the formation of muscle hernias with a change in the shape of the limb. The ligation of communicative veins is often only visual in nature.

The objective of the proposed method is to eliminate these disadvantages, increase the effectiveness of treatment, reduce trauma, reduce the likelihood of postoperative relapses, increase the cosmetic result by providing the ability to remove varicose veins through small puncture holes in trophic tissue disorders, including varicose ulcers.

To this end, in the method of surgical treatment of varicose veins of the lower extremities, including the removal of a large saphenous vein on the thigh and lower leg, varicose veins and associated communicating veins, it is proposed to carry out the removal of veins in fragments, while holding a needle with a thread under the vein and leading diametrically opposite , then through the hole of the puncture pass the needle with the thread over the vein with the output through the injection, pull the fragment of the vein with a thread and remove it, then in the same way remove sequentially with the varicose segments, lateral vein inflows and communicative veins in the varicose zone revealed by tension of the thread, and immediately apply a pressure (compression) bandage to the remote area.

Figure 1 shows a diagram of the introduction of the endovasal electrode into the large saphenous vein; figure 2 - diagram of the formation of an exciting loop in the region of varicose veins; figure 3 - extraction through a puncture of a fragment of a varicose vein.

The method is carried out in the following ways.

Under peridural anesthesia, after marking the surgical field along the varicose veins 1 (brilliant green), a large saphenous vein 2 is intersected at the place where it flows into the femoral vein 3 (Troyanov-Trelenenburg operation) with its isolation at the inner ankle 4. An endovasal electrode 5 is inserted for coagulation, along the probe in the middle third of the thigh, a large saphenous vein is grasped in loop 6 through a puncture 7 and a puncture 8, after endovasal electrocoagulation by traction movements, the large saphenous vein on the thigh and lower leg is removed I fragments along her course. According to the marking, a varicose vein 1 is captured through an injection and an injection into the loop, its traction. When the visible tension of the skin along its tributaries appears, the tributaries are first captured in the loop and removed, along with the extracted veins, temporary compression is performed. Then continue the extraction of the main varicose nodes using a loop from the thread (fishing line 0.8-1.0, depending on the caliber of the varicose vessel). At the same time, the communicating veins 9, departing from the deep veins 10, are separated in the zone of varicose nodes, and bleeding is stopped by temporary pressure. Stitches on the skin, treatment with iodine, application of pressure dressings along the removed varicose trunks with elastic bandaging of the limb.

According to the proposed method, more than 500 operations were performed, only less than 2% of postoperative complications were revealed, after one year postoperative scars were not determined, good long-term results were noted after 2-3 years.

Example.

Patient Pth Yu.B., 45 years old, was admitted with a diagnosis of varicose veins of the fourth degree, ulcers of the left lower leg 18 × 8 cm. With ultrasound scanning, the small and deep veins are passable on the left and on the right, sharply expanded. On the left tibia, perforating veins are dilated to 5 mm in the upper third of the tibia along the medial surface, in the middle third of the tibia along the posterior surface, in the lower third of the tibia along the medial surface. The operation of the proposed method. Stabilization of the leg after 10 days. The patient was discharged with a healed ulcer after 14 days.

The proposed method allows to reduce the length of the patient’s stay in the hospital, the operation time is reduced by 1.5-2 hours, the cost of the operation is low. The method allows for the treatment of all forms and stages of varicose veins, increase the radicality and cosmeticity of the operation, significantly reduce the number of postoperative complications.

Claims (1)

A method for the surgical treatment of varicose veins of the lower extremities, including the intersection of a large saphenous vein at the place of its entry into the femoral vein and its isolation at the inner ankle, the removal of a large saphenous vein on the thigh and lower leg, varicose veins and associated communicating veins, characterized in that removal of veins is carried out after endovasal electrocoagulation with fragments; in this case, a needle with a thread under a vein is carried out and diametrically opposed to the outside, then a needle with n a vein over a vein with an outlet through an injection, a fragment of a vein is pulled by a thread and it is removed, then in the same way the lateral vein inflows and communicating veins in the varicose zone that are revealed by tension of the thread are removed by strands, and a pressure is immediately applied to the removed area bandage.

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