靜脈曲張手術怎麼做？

靜脈曲張手術，在台灣目前主要有三種，傳統剝除併高位結紮、微創熱閉合、微創非熱閉合手術。

1.傳統剝除併高位結紮手術(H/L&S)

會在鼠蹊及膝蓋附近，各劃開一道傷口，將鄰近與深層靜脈相通處的隱靜脈做結紮後，再將下段隱靜脈做剝除(用抽的)。成功閉合率達78-90%，但是術中失血量較多，容易有血腫、神經受損、感染、淋巴滲漏的風險，術後疼痛感也較劇烈，住院天數也較久。

微創手術大致上可以分成熱閉合、非熱閉合手術兩種，微創手術並不是只有將傷口縮小，而是要減少正常組織的破壞，才能讓恢復的速度縮短。

2.熱閉合手術有「血管內雷射閉合手術」及「微波銷融手術」(EVLA or EMWA)

利用微創的小傷口，將雷射光纖或微波導管伸進血管內，利用熱能將血管閉合，達到阻斷逆流的結果。熱能有組織或神經損灼傷的風險，但是在專業醫師操作之下，發生的機率極低，成功閉合率90-100%，術後體內不會有人工的物質殘留，這條血管會隨著時間萎縮消失，多為門診手術，無須住院。

3.非熱閉合手術(Non-tumercent, non-thermal)

俗稱靜脈膠，利用生物膠水在管腔內將其封閉，達到阻斷逆流的結果，成功閉合率95-99%，術後可以不必穿著壓力襪或是彈性繃帶，但是有較高的機會引起血栓靜脈炎的風險。

那麼，哪一種靜脈曲張手術最好呢？靜脈曲張並沒有所謂最好的手術，應該要依據每一個人靜脈曲張的成因、解剖位置、血管特性、體質來選擇最適合的手術，並不是所謂最新或是最貴，就是最好的，應該要根據醫師的檢查結果，討論選擇最適合的治療方式！

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