RU2316273C1 - Method for treating varicose veins of inferior limbs - Google Patents

Abstract

FIELD: medicine, surgery, phlebology.

SUBSTANCE: it is necessary to wind around a varicose vein with a ligature by type of uninterrupted spiral suture at its whole length. Moreover, one should carry out subcutaneous fixation of the ligature in the form of a triangle: out of three cutaneous paracentesis sites, at triangle's top and ligature output being at the distance of 3-5 cm lower and median against varicose conglomerate; while applying the ligature it is necessary to capture skin and fascia along triangle's lateral sides, and along its bottom one should capture the skin only, the output of ligature should be fixed with a triple knot before putting into tissues; subcutaneously one should apply the ligature into area of varicose conglomerate, form uninterrupted spiral suture, moreover, after each applied coil one should fulfill the ligature's tension till complete squeezing of varicose nodes. At the same time, in every 4 coils one should apply additional ligature (its length being about 12-14 cm)over the main ligature, which should be put subcutaneously at tension, and its ends should be left on skin, then higher and median against varicose conglomerate one should fix the ligature in the form of a triangle, and 10-12 later ligatures should be removed. The innovation enables to achieve complete obliteration of large-sized varicosed conglomerates and veins at the whole length that decreases the frequency of post-surgical relapses.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to surgery and can be used in the treatment of varicose veins of the lower extremities.

There is a method of treating varicose veins (RF Patent No. 2102930, IPC АВВ 17/00, publ. 1998), which includes suturing a vein in the form of "figure eight" with the formation of a skin area 3-4 mm long between the points of entry and exit of the needle , at the end of the postoperative period, the sutures are removed, sclerosant is introduced into the remaining lumen of the vein.

The disadvantage of this method is that with this fixation it is impossible to achieve complete compression of the vessel, and the introduction of sclerosant does not provide a sufficient guarantee of the complete obliteration of the vessel, because it is impossible to achieve complete removal of blood from the vessel before the introduction of sclerosant. A fixing pad in the area of the ligature knot of 3-4 mm will lead to the formation of pressure sores and skin necrosis.

A known method of percutaneous ligation of varicose veins of the lower extremities (RF Patent No. 20055420, IPC АВВ 17/04, publ. 1994, prototype), including twisting of varicose veins according to the type of continuous spiral suture throughout. A long silk thread is carried out with a straight needle under and above the varicose vein, the thread and needle are removed and carried out at the sites of injection and puncture of the needle. After suturing, the ends of the threads are stretched and fixed to the skin. Sutures are cut off in the skin on the 10th day after surgery. The thread remains around the strangulated vein.

The disadvantages of this method are the impossibility of its use in large varicose conglomerates of the lower leg and thigh, the presence of ligatures remaining in the subcutaneous tissue space, which leads to the risk of suppuration and the formation of ligature fistulas. The remaining long stump of the saphenous vein in the upper third of the thigh leads to a risk of relapse and thromboembolism, as Operation Troyanov-Trendelenburg not performed.

The objective of the invention is to eliminate these disadvantages, increasing the effectiveness of treatment due to scarring of the veins with the help of a submersible removable suture.

To this end, in a method of treating varicose veins of the lower extremities, including twisting of varicose veins as a continuous spiral suture along the entire length, it was proposed to initially perform subcutaneous fixation of the ligature below the varicose zone in the form of a triangle with an apex under the varicose vein with grabbing of skin and fascia along the sides of the triangle and the output of the thread at a distance of 3-5 cm under varicose veins. In this case, the output of the thread is fixed with a triple knot before immersion in tissue, then a ligature is carried out cutaneously to the edge of varicose veins, and when a continuous spiral seam is formed after each superimposed turn, the ligature is tensioned until the varicose nodes are completely compressed. After every 4 turns, an additional ligature of 12-14 cm is thrown onto the long main ligature, which is immersed subcutaneously with tension, and its ends are left on the skin, then fixation is applied at the upper point of varicose veins similarly to the lower one, after 10-12 days, the entire ligature is removed.

During this operation, the venous wall is not injured, which eliminates blood loss. The fact that the subcutaneous fixative ligature in the form of a loop is installed first under varicose veins, allows you to make a spiral twisting seam with strong tension of the ligature and subsequent fixation over varicose veins, provides a high degree of sclerosis due to compression and displacement of varicose trunks in three planes, eliminating the possibility of restoration of vascular lumen. Subcutaneous fixation of the ligature eliminates pressure sores and necrosis of the skin. Additional ligatures provide complete removal of the curling removable seam.

The drawing shows a diagram of the imposition of a twist immersion removable seam.

The implementation of the method is shown in a specific clinical example.

Example

Patient L., 48 years old, was admitted to the department of vascular surgery with complaints of pain in the region of varicose nodes of the left lower limb after exercise, heaviness in the legs. He is ill for 18 years, he associates varicose veins with heredity. The patient's condition is satisfactory. By internal organs without deviations from the norm. A / D 130/80 mm Hg Pulse 64 beats / min. In the area of the left lower extremity there is a failure of the ostial valve and perforating vein valves, large varicose nodes on the left lower leg. The diameter of the large saphenous vein at the mouth is 4 cm, the diameter of varicose nodes on the lower leg is from 1 to 8 cm, without a clear boundary between the varicose extensive conglomerates.

The operation was performed under epidural anesthesia. After isolation of a large saphenous vein and its ligation after endovasal electrocoagulation, a submersible removable suture was applied. Imposing a submersible removable suture began with the formation of a locking “lock” in the form of a triangle in the foot area of three skin punctures at a distance of 3 cm from the lower edge of the varicose conglomerate.

Using a needle with a removable handle charged with a ligature: length 8 vinyl chloride line, an injection was made in an oblique direction with a deep grip of the skin and fascia and a puncture, then a puncture was made through the same puncture hole and held horizontally surface under the skin with a puncture at the next injection -protection. Thus, the base of the triangle was obtained, then again injected through the puncture hole with a deep grip of tissues with a puncture into the existing first puncture hole - a fixation triangle is formed.

At the top of the triangle, the end of the ligature and its long portion located in the needle were tied with a triple tight knot with the tension of the locking “lock” so that the knotted knot plunged into the puncture hole at the top of the triangle. At the same time, an exciting loop was formed under the skin from the triangle. The needle led the long end of the line through the fourth puncture hole, leaving through a puncture in the region of the edge of the varicose conglomerate. Then, a subcutaneous conduction of vinyl chloride line through the injections and punctures was made, passing under and above the varicose conglomerate, they formed an immersive, continuous spiral around it. The spiral was not fixed on the skin, the distance between the turns was 1-2 cm. After each applied turn, the ligature was tensioned until the varicose nodes were completely compressed. After every 4 turns, an additional ligature 12-14 cm long was thrown onto the long main ligature, which was subcutaneously immersed when tensioned, and its ends were left on the skin for future free removal of the twisted removable seam. After applying a twisted spiral removable seam to the entire varicose conglomerate, a fixing “lock” was applied at the upper point, backing 3-4 cm on the edge of the conglomerate towards the medial surface of the knee joint, similar to the lower fixing triangle.

On the 10th day the suture was removed, the patient was discharged for outpatient treatment. Disability recovery 30 days after the operation. Examination after a year: no recurrence of varicose veins, complete absence of scars.

Depending on the location of the varicose conglomerate, the ligature is fixed on the foot, lower leg, and thigh.

The developed technique was used to treat varicose veins in 45 people. The immediate and long-term postoperative complications were not noted. The operation time is 30-50 minutes. Patients were monitored from a year to ten years. Relapse of varicose veins was not observed. The cosmetic effect is good.

The proposed method allows surgical treatment of all degrees of chronic venous insufficiency (CVI). It is the method of choice for CVI 1-4 degrees in the presence of large varicose conglomerates, the period of incapacity for work compared with the operations of Linton and Bebkokok and their modifications is small. The operation is less traumatic, gives a good cosmetic result.

Claims (1)

A method of treating varicose veins of the lower extremities, including entwining a varicose vein with a ligature according to the type of continuous spiral suture along the entire length, characterized in that they produce subcutaneous fixation of the ligature in the form of a triangle: from three skin punctures, with the apex of the triangle and the thread exit at a distance of 3-5 cm below and medial of the varicose conglomerate, during the ligature they capture the skin and fascia along the sides of the triangle, and at the base of the triangle they capture only the skin, I fix the ligature exit a triple knot before immersion in the tissue, subcutaneously carry out a ligature into the region of the varicose conglomerate, form a continuous spiral seam, and after each superimposed turn, the ligature is tensioned until the varicose nodes are completely compressed, at the same time, an additional 12 ligature is thrown onto the main ligature every 4 turns -14 cm, which is immersed subcutaneously under tension, and its ends are left on the skin, then a ligature in the form of a triangle is fixed higher and more medially of the varicose conglomerate, after 10-12 days of ligature in give away.

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