Đánh giá kết quả sớm điều trị suy tĩnh mạch nông chi dưới mạn tính bằng laser nội tĩnh mạch tại Bệnh viện Đa khoa Trung ương Quảng Nam=Evaluation of early results of endovenous laser treatment for inferior extremity superficial venous insufficiency at Quang Nam Central General Hospital

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Minh Hòa Bùi, Đình Hùng Nguyễn, Tấn Quang Phan, Thị Nghĩa Phan

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Y học cộng đồng, 2024

Mô tả vật lý: tr.178-183

Bộ sưu tập: Metadata

ID: 242264

Thêm vào giỏ

Suy giãn tĩnh mạch chi dưới là một bệnh lý phổ biến. Bệnh ảnh hưởng nhiều đến thẩm mỹ và chất lượng cuộc sống của bệnh nhân. Bệnh viện Đa khoa Trung ương Quảng Nam đã tiến hành điều trị suy tĩnh mạch nông chi dưới bằng LASER nội mạch lần đầu tiên vào tháng 11/2019. Cho đến nay phương pháp điều trị này đã dần phổ biến hơn. Mục tiêu nghiên cứu: Đánh giá kết quả sớm (sau 4 tuần) điều trị suy tĩnh mạch nông chi dưới mạn tính bằng LASER nội tĩnh mạch. Đối tượng và phương pháp: Tiến cứu có can thiệp. Nghiên cứu thực hiện trong 18 tháng (5/2022-10/2023). Các bệnh nhân suy giãn tĩnh mạch nông chi dưới đủ tiêu chuẩn lựa chọn được can thiệp điều trị bằng LASER nội tĩnh mạch hiển. Đánh giá kết quả sau 4 tuần qua thăm khám lâm sàng đánh giá sự cải thiện triệu chứng và siêu âm Doppler tĩnh mạch đánh giá hiệu quả tắc mạch và biến chứng điều trị. Kết quả nghiên cứu: Trung vị chiều dài của đoạn tĩnh mạch hiển lớn được làm LASER nội mạch là 42 cm. Chiều dài đoạn tĩnh mạch hiển bé được làm LASER là 18 cm. Năng lượng LASER trung bình được sử dụng trong nghiên cứu cho điều trị suy tĩnh mạch hiển lớn là 61,99 ± 5,63 J/cm, cho tĩnh mạch hiển bé là 68,3 J/cm. Thay đổi phân độ lâm sàng CEAP-C sau LASER nội mạch: CEAP-C2 giảm từ 61,8% còn 14,7%
CEAP-C3 giảm từ 11,8% còn 0%
CEAP-C4a giảm từ 14,7% còn 5,9%
CEAP-C4c giảm từ 11,8% còn 2,9%. Trung vị điểm VCSS sau can thiệp giảm 3 điểm so với trước can thiệp, sự khác biệt có ý nghĩa thống kê. Đường kính tĩnh mạch sau can thiệp giảm có ý nghĩa thống kê so với trước can thiệp (từ 5,86 mm trước can thiệp giảm xuống còn 3 mm sau can thiệp). Sau can thiệp, tất cả các tĩnh mạch hiển được LASER nội mạch đều tắc hoàn toàn và không còn dòng chảy. Biến chứng thường gặp nhất sau can thiệp LASER nội tĩnh mạch là đau dọc đường đi tĩnh mạch (88,2%) và bầm tím dọc đường đi đoạn tĩnh mạch được làm LASER (67,6%). Các biến chứng này thường nhẹ và chóng hồi phục. Kết luận: LASER nội tĩnh mạch là phương pháp điều trị an toàn, hiệu quả, thẩm mỹ cho bệnh lý suy giãn tĩnh mạch nông chi dưới.Varicose veins of the lower limbs is a common disease. The disease greatly affects the patient's aesthetics and quality of life. At Quang Nam Central General Hospital, treatment of superficial lower limb venous insufficiency with endovenous LASER ablation was performed for the first time in November 2019. Up to now, this treatment method has gradually become more popular. Objective: Evaluate early results (after 4 weeks) of treating superficial lower limb venous insufficiency with endovenous LASER ablation. Subjects and methods: Prospective intervention. The study will be conducted in 18 months (May 2022 - October 2023). All patients meeting for selection criterion were treated with endovenous LASER ablation. Evaluating results after 4 weeks through clinical examination to evaluate symptom improvement and venous Doppler ultrasound to check embolization effectiveness, and evaluating complications of treatment. Results: The median length of the great saphenous vein segment treated with endovascular LASER was 42 cm. The length of the small saphenous vein lasered is 18 cm. The average LASER energy used in the study for the treatment of greater saphenous vein insufficiency was 61 . 99 ± 5 . 63 J/cm, for the small saphenous vein it was 68 . 3 J/cm. Change in CEAP - C clinical grading after intravascular LASER : CEAP - C2 decreased from 61 . 8% to 14 . 7%
CEAP - C3 decreased from 11 . 8% to 0%
CEAP - C4a decreased from 14 . 7% to 5 . 9%
CEAP - C4c decreased from 11 . 8% to 2 . 9%. The median VCSS score after interv ention decreased by 3 points compared to before intervention, this difference is statistically significant. Vein diameter after intervention decreased statistically significantly compared to before intervention (from 5 . 86 mm before intervention to 3 mm aft er intervention). After intervention, all saphenous veins treated with endovascular LASER were completely occluded and had no flow. The most common complications after endovenous LASER intervention are pain along the vein path (88.2%) and bruising along th e LASER vein path (67.6%). These complications are usually mild and recover quickly. Conclusion: Endovenous LASER is a safe, effective, and aesthetic treatment method for superficial varicose veins of the lower limbs.

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