股浅静脉带戒术联合内镜下交通静脉离断术治疗复发性下肢静脉功能不全.DOCVIP

临床医学论文-股浅静脉带戒术联合内镜下交通静脉离断术治疗复发性下肢静脉功能不全 ???????????? 作者：陈旭明 王晓栋 韩伟 娄尧强 王林君 张强? 【摘要】? 目的 评价股浅静脉带戒术联合内镜下交通静脉离断术（subfascial endoscopic perforator vein surgery，SEPS）治疗复发性下肢静脉功能不全（lower extremity vein insufficiency，LEVI）的疗效。 方法 35例36条肢体复发性LEVI，术前全部行股浅静脉、交通静脉B超及下肢深静脉顺行造影检查，其中7例8条肢体（A组）原大隐静脉主干未抽剥仅行浅静脉手术；28例大隐静脉主干已抽剥者随机分为B组和C组，各14例，B组行浅静脉手术+股浅静脉带戒术，C组行浅静脉手术+股浅静脉带戒术联合SEPS。术后2、12、18个月 B超检测股浅静脉返流时间及交通静脉功能不全（perforating vein incompetence，PVI）存在情况，观察患肢症状改善及溃疡愈合、复发情况。结果 术前B超及深静脉造影检查显示A组中的5条、B组和C组28条肢体全部存在股浅静脉返流，返流时间0.5s，36条肢体均存在PVI。术后2、12、18个月B超随访，A组的5条肢体返流加重，PVI存在的例数分别为5、5、5；B组和C组均无股浅静脉返流，PVI存在的例数为0。 结论 股浅静脉带戒联合SEPS，不仅修复了深静脉瓣膜功能，而且离断了引起复发、皮肤色素沉着、水肿、难治性溃疡等一系列并发症的交通静脉，近期疗效肯定。 【关键词】? 股浅静脉带戒术 内镜下交通静脉离断术 复发 静脉功能不全 　　【Abstract】? Objective? To evaluate the effect of external valvuloplasty of superficial femoral vein valve combined with subfascial endoscopic perforator vein surgery(SEPS) in treating recurrent lower extremity vein insufficiency(LEVI）. Methods?? 36 limbs of recurrent LEVI in 35 cases were enrolled in this study , superficial femoral vein、perforating vein incompetence were all applied with B ultrasound examination and intravenous antegrade angiography of deep vein of inferior member before operation ,8 limbs in 7 cases among them were only operated on superficial vein and the main great saphenous vein was remained ; 28 cases in which main great saphenous vein was drawn out were divided into 2 groups ( group B and C ), in group B , operation on superficial vein and external valvuloplasty of superficial femoral vein valve were applied ; in group C ,operation on superficial vein and external valvuloplasty of superficial femoral vein valve combined with subfascial endoscopic perforator vein surgery(SEPS)were applied. B ultrasound examination was applied to assess the back flow time and existence of perforating vein incompetence(PVI）,the symptomatic improvement 、healing of ulcer and recurrence were observed 2 months 、12 months and 18 months postoperatively . Results? The B ul