股浅静脉瓣膜环形缩窄术治疗原发性下肢深静脉瓣膜功能不全疗效评价  

The evaluation for the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency

作　　者：张皓[1] 吕杰捷[1] 张纪蔚[1] 张柏根[1] 

机构地区：[1]上海第二医科大学附属仁济医院血管外科,200001

出　　处：《中华外科杂志》2004年第18期1121-1124,共4页Chinese Journal of Surgery

摘　　要：目的　评价股浅静脉瓣膜环形缩窄术治疗原发性下肢深静脉瓣膜功能不全的疗效和应用价值。方法　 97例 (97侧肢体 )经静脉顺行造影证实为原发性下肢深静脉瓣膜功能不全的患者分为A、B两组 ,A组 79例 ,B组 18例。A组行大隐静脉高位结扎剥脱术加交通支结扎术同时行股浅静脉瓣膜环形缩窄术 ,B组仅行大隐静脉高位结扎剥脱术加交通支结扎术。以CEAP临床分类与临床记分和顺行性下肢静脉造影评价疗效。结果　A、B两组术后临床记分均明显下降 (A组P <0 0 1;B组P <0 0 5 )。A组中C5～C6者手术效果较C2 ～C4者好 ;两组C2 ～C4者比较 ,A组手术效果优于B组。术后A组中 6 7侧患肢行顺行性下肢静脉造影 ,瓣膜功能恢复有效率为 83 5 8% (5 6 /6 7) ,显效率为 4 1 79% (2 8/6 7) ;B组 12侧患肢股浅静脉瓣膜功能恢复有效率为 33 33% ,两组有效率比较 ,有显著性差异 (P <0 0 5 )。结论　大隐静脉高位结扎加交通支结扎加股浅静脉瓣膜环形缩窄术 ,较大隐静脉高位结扎加交通支结扎术更有助于临床症状缓解和瓣膜形态功能的恢复。术前明确诊断为原发性下肢深静脉瓣膜功能不全患者 ,宜行股浅静脉瓣膜环形缩窄手术。Objective To evaluate the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI) Methods Ninety-seven limbs in 97 patients who were proved to be PDVI by ascending venography were divided into Group A (79 limbs) and Group B (18 limbs)Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veinsAnd they were also treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins at the same timePatients of Group B were simply treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veinsAscending venography and CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation Results The difference between preoperative and postoperative scores of Group A and Group B were both remarkable (Group A,P<001; Group B,P<005)The difference of scores, which equated to preoperative scores minus postoperative score, between Group A and Group B were also prominent (P<001)Post-operation ascending venography was performed on 67 limbs in Group AThe effective rate of the operation is 8358%(28+28/67), obviously effective rate is 4179%(28/67)Same exam was performed on 12 limbs in Group B and the effective rate of the operation is 3333%The difference between two groups' effective rate is significant (P<005) Conclusions Clinical scoring of Group A decreased much more than Group B; The effective rate of Group A in ascending venography is also much higher than Group BEncircling constriction of superficial femoral vein is useful to relief the symptom and recover the shape and function of the valve of superficial femoral veinsThose who are diagnosed to be PDVI by means of pre-operation ascending venography and Valsalva test should accept the operat

关 键 词：股浅静脉 原发性下肢深静脉瓣膜功能不全 治疗 结扎术 有效率 大隐静脉高位结扎剥脱术 下肢静脉造影 恢复 肢体 

分 类 号：R654.4[医药卫生—外科学] R543[医药卫生—临床医学]