爱爱医资源-周围血管疾病课件-华西医院血管外科.pptVIP

动脉粥样硬化性闭塞症 尚不清楚 易患因素：年龄45岁，糖尿病、高脂血 症、吸烟、高血压等 病变部位：腹主动脉，髂、股动脉，月国 动脉及分叉部 血管闭塞性疾病治疗技术前沿血管腔内治疗 经皮血管腔内成形术（Percutaneous Transluminal Angioplasty, PTA) 经皮血管腔内支架(Stent)置入术 Summary Primary varicose vein of lower extremities: superficial vessel that is abnormally lengthened, twisted, or dilated, seen most often on the legs and thighs. Varicose veins develop spontaneously, and are usually attributed to a hereditary weakness of the vein; the valves in the vein that keep the blood circulating upward toward the heart are usually incompetent. Increased pressure from long standing or exertion, or internal factors such as pregnancy, or lessened support by the tissues surrounding the veins that occurs with aging and obesity causes the weakened veins to dilate. Mild varicosities often cause no discomfort. Persons with more severe cases may develop swelling of the legs, ankles, and feet, and local eczema or ulcers. Mild varicosities may be treated with rest, elevation of the legs, and the use of elastic bandages or stockings. In severe cases surgical treatment may be necessary. 诊疗流程图 患肢浅静脉扩张、弯曲、甚至蜷曲成团伴色素沉着、脱屑、瘙痒、湿疹和溃疡 Ｐerthe试验（深静脉通畅试验）和（Trendelenberg）试验（大隐静脉瓣膜功能试验）  彩色多普勒超声或静脉造影检查深静脉通畅和返流 原发性下肢静脉曲张 继发性下肢静脉曲张 （深静脉通畅和无返流） （深静脉阻塞或有返流)（鉴别诊断） 大隐静脉高位结扎剥脱术 深静脉修复术和浅静脉剥脱术 非手术治疗：弹力袜 非手术治疗：弹力袜 前沿进展 目前原发性大隐静脉曲张外科治疗主要向微创化治疗发展，外科治疗原则是高位结扎大隐静脉，剥脱曲张静脉，结扎或破坏交通静脉。主要治疗手段为大隐静脉高位结扎和曲张大隐静脉点式剥脱术，新近也采用大隐静脉激光，射频，电凝闭塞主干，曲张大隐静脉旋切手术，但远期疗效尚待进一步观察。 并发症及处理1.血栓性静脉炎： 穿弹力袜或用弹力绷带2.湿疹和溃疡形成： 控制感染，局部换药3.急性出血： 加压包扎、必要时缝扎出血 　　指下肢浅静脉系统处于伸长、蜿蜒而曲张状态，多发于持久从事站立工作或体力劳动者。 病 因　　下肢静脉血柱重力以及任何加强重力作用的后天因素，如：长期站立工作，重体力劳动、妊娠、慢性 咳嗽、习惯便秘、使静脉瓣膜承受过度压力、渐松驰、瓣膜关闭功能受到破坏，致相对关闭不全。 大隐静脉(Long saphenous vein) ：行程、属支→入股静脉、 无动脉伴行、无肌肉直 接挤压小隐静脉(Short saphenous vein) ：行程、位置→入腘静脉 浅 静 脉 解剖和生理