اﺳﺘﻔﺎده از ﻟﻴﺰر داﺧﻞ رگ ﺑﺮاي درﻣﺎن ﻧﺎرﺳﺎﺋﻲ درﻳﭽﻪ اي ورﻳﺪ ﺳﺎﻓﻦ در 69 ﺑﻴﻤﺎر: ﻧﺘﺎﻳﺞ 16 ﻣﺎﻫﻪ

Use of Endovascular Laser for Treatment of Saphenous Vein Reflux in 69 Patients: Results after 16 Months

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻭﺍﺭﻳﺲ ﺑﻴﻤـﺎﺭﻱ ﺑﺴﻴﺎﺭ ﺷﺎﻳﻊ ﺍﺳﺖ ﻭ ﺑﻪ ﻏﻴﺮ ﺍﺯ ﺯﺷﺘﻲ ﭘﺎ ﻋـﻮﺍﻗﺐ ﺁﺯﺍﺭﺩﻫﻨـﺪﻩ ﻭ ﺩﺭ ﺑﻌﻀﻲ ﻣـﻮﺍﺭﺩ ﺧﻄـﺮﻧﺎﮐﻲ ﻧﻴﺰ ﺩﺍﺭﺩ. ﺍﺳﺎﺱ ﺩﺭﻣﺎﻥ ﺑﺮ ﺩﻭ ﭘﺎﻳﻪ ﺍﺳﺘـﻮﺍﺭ ﺍﺳﺖ. ﺍﻭﻝ ﻣﺘـﻮﻗﻒ ﻧﻤﻮﺩﻥ ﺑﺮﮔﺸﺖ ﻏـﻴﺮ ﻃﺒﻴﻌﻲ ﺧﻮﻥ ﺩﺭ ﺳﻴﺴﺘﻢ ﺳﻄﺤﻲ ﻭ ﺩﻭﻡ ﺧﺎﺭﺝ ﻭ ﻳﺎ ﻣﺴﺪﻭﺩ ﻧﻤـﻮﺩﻥ ﺭﮒ ﻫﺎﻱ ﻭﺍﺭﻳﺴﻲ. ﮔﺮﭼﻪ ﺭﻭﺵ ﺟﺮﺍﺣﻲ ﻭ ﺗﺰﺭﻳﻖ ﺩﺭﻣﺎﻧﻲ ﻣـﻮﻓﻖ ﺍﺳﺖ ﻭ ﺩﺭ ﮔﺬﺷﺘﻪ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻃﻼﺋﻲ ﻣﺤﺴﻮﺏ ﻣﻲ ﺷﺪ ﻭﻟﻲ ﺑﺎ ﺗﻮﺟـﻪ ﺑﻪ ﺑﺮﺧﻲ ﻋـﻮﺍﺭﺽ، ﺩﺭ ﺳﺎﻝ ﻫﺎﻱ ﺍﺧﻴـﺮ، ﺑﺎ ﻫـﺪﻑ ﮐﺎﻫـﺶ ﻋـﻮﺍﺭﺽ، ﺁﺳﺎﻧﺘـﺮ ﻭ ﺑﺎ ﺩﻭﺍﻡ ﺗﺮ ﻧﻤﻮﺩﻥ ﺩﺭﻣﺎﻥ، ﺍﺯ ﺭﻭﺵ ﻫﺎﻱ ﻣﺘﻔـﺎﻭﺗﻲ ﺍﺯﺟﻤﻠﻪ ﻧﻮﺭ ﻟﻴـﺰﺭ ﺍﺳﺘﻔـﺎﺩﻩ ﺷـﺪﻩ ﺍﺳﺖ. ﻫـﺪﻑ ﺍﻳﻦ ﻣﻘـﺎﻟﻪ ﺍﺭﺯﻳﺎﺑﻲ ﺭﻭﺵ ﻟﻴـﺰﺭ ﺩﺍﺧـﻞ ﺭﮒ ﺑﺮﺍﻱ ﻣﺴﺪﻭﺩ ﻧﻤـﻮﺩﻥ ﺭﮒ ﺳﻄﺤـﻲ ﻣﻲ ﺑﺎﺷﺪ. ﻣـﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﻣﻄﺎﻟﻌـﻪ ﺍﺯ ﻧﻮﻉ ﻛﺎﺭﺁﺯﻣـﺎﺋﻲ ﺑﺎﻟﻴﻨـﻲ ﺑـﻮﺩﻩ ﮐﻪ ﺩﺭ ﺁﻥ ﺑﻴﻤـﺎﺭﺍﻥ ﻳﮑـﻲ ﺑﻌـﺪ ﺍﺯ ﺩﻳﮕـﺮﻱ ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﻧﺎﺭﺳﺎﺋﻲ ﺩﺭﻳﭽـﻪ ﺍﻱ ﺩﺭ ﺳﻴﺴﺘـﻢ ﺳﻄﺤـﻲ ﺳﺎﻓـﻦ ﺑﻠﻨﺪ ﻭ ﮐـﻮﺗﺎﻩ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﻭﺍﺭﻳﺲ ﺍﻭﻟﻴﻪ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﻟﻴـﺰﺭ 980 ﻧﺎﻧﻮ ﻣﺘﺮﻱ ﺩﺍﺧﻞ ﺭﮒ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﺗﻤـﺎﻡ ﺑﻴﻤـﺎﺭﺍﻥ ﭘﻴﺶ ﺍﺯ ﻋﻤـﻞ ﻭ10 ﺍﻟﻲ 14 ﺭﻭﺯ ﺑﻌـﺪ ﺍﺯ ﻋﻤﻞ ﻣﻌﺎﻳﻨﻪ ﻭ ﺗﺤﺖ ﺁﺯﻣﺎﻳﺶ ﺩﺍﭘﻠـﺮ ﺭﻧﮕﻲ ﻗﺮﺍﺭ ﻣﻲ ﮔﻴﺮﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺗﻌﺪﺍﺩ 76 ﺭﮒ ﺩﺭ 69 ﺑﻴﻤـﺎﺭ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻟﻴـﺰﺭ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ، 64 ﺭﮒ ﺳﺎﻓﻦ ﺑﻠﻨﺪ ﻭ 12 ﺭﮒ ﺳﺎﻓـﻦ ﮐﻮﺗﺎﻩ. ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﺘﻮﺳﻂ ﺍﻧﺮﮊﻱ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﺭﮒ ﻫﺎ 2487 ﮊﻭﻝ ﺑﻮﺩ، ﺯﻣﺎﻥ ﻣﺘﻮﺳﻂ 154ﺛﺎﻧﻴﻪ ﻭ ﺗﻌـﺪﺍﺩ ﻣﺘﻮﺳﻂ ﭘﺎﻟﺲ 103ﺑﻮﺩ. ﺍﻧﺪﺍﺯﻩ ﻣﺘﻮﺳﻂ ﻗﻄﺮ ﺭﮒ ﺳﺎﻓـﻦ ﺑﻠﻨﺪ ﺩﺭ ﻗﺴﻤـﺖ ﺑﺎﻻ 10/87 ﻣﻴﻠﻲ ﻣﺘﺮ ﭘﻴﺶ ﺍﺯ ﺷﺮﻭﻉ ﻭ ﺑﻌﺪ ﺍﺯ ﺩﺭﻣﺎﻥ 7/42 ﻣﻴﻠﻲ ﻣﺘﺮ ﺍﺧﺘﻼﻑ ﺑﻴﻦ ﺍﻧﺪﺍﺯﻩ ﻫﺎﻱ ﺭﮒ ﻫﺎ ﭘﻴﺶ ﺍﺯ ﺷﺮﻭﻉ ﻭ ﺑﻌﺪ ﺍﺯ ﺩﺭﻣﺎﻥ ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﻗﺎﺑﻞ ﺗﻮﺟـﻪ ﻫﺴﺘﻨﺪ (Students t Test; P<.0001). ﺩﺭ ﻣﻌﺎﻳﻨﻪ ﮐﻪ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺍﻧﺠﺎﻡ ﺷﺪ ﺍﺯ 76 ﺭﮒ ﻟﻴﺰﺭ ﺷـﺪﻩ 73 ﺭﮒ ﺗﺎ ﻣﺤﻞ ﺗﻘﺎﻃﻊ ﻣﺴﺪﻭﺩ ﺑﻮﺩ. ﻓﻘﻂ ﺩﺭ ﺳﻪ ﻣﻮﺭﺩ، 4 -2 ﺳﺎﻧﺘﻴﻤﺘﺮ ﻧﺰﺩﻳﮏ ﺩﻭ ﺭﺍﻫـﻲ ﺑﻴﻦ ﺭﮒ ﺳﻄـﺤﻲ ﻭ ﻋﻤﻘـﻲ ﺑﺎﺯ ﺑﻮﺩ ﻭﻟﻲ ﺑﻘﻴﻪ ﻃﻮﻝ ﺭﮒ ﻫﺎ ﻣﺴـﺪﻭﺩ ﺑﻮﺩ. ﺩﺭﺗﻤﺎﺱ ﺗﻠﻔﻨـﻲ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ 98 ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﺩﺭﻣـﺎﻥ ﺭﺍﺿﻲ ﺑﻮﺩﻧﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﻣﻲ ﺩﻫﺪ ﮐﻪ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻟﻴـﺰﺭ ﺩﺍﺧﻞ ﺭﮒ ﺑﺮﺍﻱ ﻣﺴﺪﻭﺩ ﻧﻤﻮﺩﻥ ﺳﺎﻓﻦ ﻭ ﺩﺭﻣﺎﻥ ﺑﺮﮔﺸﺖ ﺧﻮﻥ ﻭﺭﻳﺪﻱ ﻣـﻮﻓﻖ ﻣﻲ ﺑﺎﺷﺪ. ﻫﻤـﺮﺍﻩ ﺑﺎ ﺭﺿﺎﻳﺖ ﺑﺎﻻﻱ ﺑﻴﻤﺎﺭﺍﻥ، ﺍﻳﻦ ﺭﻭﺵ ﺩﺭﻣﺎﻧﻲ ﻣﻲ ﺗﻮﺍﻧﺪ ﺑﻪ ﺁﻥ ﮔﺮﻭﻩ ﻭﺳﻴﻊ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﮐﻪ ﺑﺮﺍﻱ ﺩﺭﻣﺎﻥ ﺍﻗـﺪﺍﻡ ﻧﻨﻤـﻮﺩﻩ، ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺍﻳﻦ ﺭﻭﺵ ﻣﻲ ﺗﻮﺍﻧﻨﺪ ﻭﺍﺭﻳﺲ ﺧـﻮﺩ ﺭﺍ ﺑﺎ ﺍﻃﻤﻴﻨﺎﻥ ﺑﻴﺸﺘﺮ ﺩﺭﻣﺎﻥ ﮐﻨﻨﺪ.

re serious consequences. This has been done in past by surgery which has some limitations and for this reason different methods to replace vein stripping have been tried. The aim of this article is to evaluate the use of endovascular laser. Materials & Methods: This study was a clinical trail. Patients with varicose veins due to saphenous incompetence were treated with endovascular 980 nm diode laser as a treatment of venous reflux. Clinical and duplex assessment of all patients was performed prior to operation and 10-14 days after operation. Results: The numbers of 76 saphenous veins in 69 patients were treated by Endovenous laser, receiving on average 2487 joules in 103 pulses in 154 seconds. The preoperative diameter of the saphenofemoral junction was 10.58 mm and this compares with post laser diameter at 10-14 days of 7.42 mm. This difference is statistically significant (students t test; P<0.001). Post laser examination showed that of the 76 saphenous veins 73 were completely occluded up to the junction and in three veins only the upper 2-4 cm was patent but the rest of the vein was occluded. 98% of patients were satisfied with the result of the treatment of the varicose veins. Conclusions: This study demonstrates that endovascular 980 nm diode laser is 96% effective in ablating incompetent saphenous vein with 98% satisfaction with the treatment. This method may help undecided varicose vein sufferers to seek effective treatment