大隐静脉抽剥对下肢深静脉瓣膜功能影响.docVIP

大隐静脉抽剥对下肢深静脉瓣膜功能影响 　　【摘要】 目的 研究大隐静脉激抽剥术治疗下肢慢性静脉功能不全对改善深静脉瓣膜功能的作用。方法 收集45例(50条肢体)住院治疗的下肢下肢慢性静脉功能不全的患者,行大隐静脉高位结扎剥脱术。所有患者术前均经过双功能彩色多普勒超声检查记录深静脉血流动力学指标,手术后3个月对患者进行随访,比较手术前后深静脉瓣膜功能是否有改善及改善的程度。结果 除6例共7条患肢术后3个月未见明显降低级别外,其余患肢所有患肢术后均出现深静脉功能级别下降1级或1级以上;术前深静脉功能记分为139,术后3个月降到93,差异有显著性(P0.01)。血流动力学指数(股浅静脉第一对瓣膜返流时间与返流最大流速)术后均显著改善(P0.05)。结论 大隐静脉激抽剥术治疗下肢慢性静脉功能不全的有效术式,并且确实可以在一定程度上改善深静脉瓣膜功能。 　　【关键词】 　　静脉曲张;剥脱术;深静脉瓣膜功能 　　 　　Effect of deep venous valve function after the stripping of saphenous vein 　　 　　 　　【Abstract】 Objective To evaluate the effect on deep venous valve function after proximal saphenous vein ligation and ablation of varicose veins in treatment of chronic venous insufficiency(CVI)of lower limbs.Methods Forty five(50 limbs)cases with CVI were enrolled to accept surgical management of vein systems.Each patient was detected with Color Doppler Ultra sonography,whose deep venous hemodynamics index was measured and recorded preoperation and three month after operation.Results Except 6(7 limbs)cases without degradation of deep venous valve function class post operation,the others cases are all decrease one or more.The scoring of deep venous valve function post operation are significantly decrease from 139(preoperation)to 93(P0.01).The index of deep venous hemodynamics(back flow time and peak flow rate of back flow)has prominent improvement after operation(P0 05).Conclusion It is effective way of proximal saphenous vein ligation and ablation of varicose veins in treatment of CVI and it is confirmed that it can improve deep vein valve function in some extent. 　　【Key words】 　　Varicose veins; Stripping;deep venous valve function 　　 　　DOI:10.3760/cma.j.issn2010.01.52 　　作者单位:523018东莞市人民医院手外科 　　 　　下肢慢性静脉功能不全(chronic venous insufficiency,CVI)是国人常见的血管外科疾病。人们最早认识的是以大隐静脉曲张为代表的浅静脉功能不全。20世纪初Homans就提出治疗大隐静脉曲张的手术方式“大隐静脉高位结扎、抽剥术”,至今仍为治疗该病的经典手术方式。 　　浅静脉曲张发生后,沿着大隐静脉的血液返流又可通过交通静脉重新进入深静脉系统而增加深静脉的负荷,最终引起深静脉扩张和延长,瓣膜功能损害。有人提出浅静脉手术不仅可以有效治疗浅静脉功能不全所致的CVI,而且可以减少或消除浅静脉系统向深静脉的回流量,从而降低深静脉的容量和压力,