重症下肢深静脉血栓形成后综合征的外科治疗  

Surgical Treatment for Severe Post Thrombotic Syndrome

作　　者：孙岩[1] 刘洋[1] 袁海[1] 张静勇[1] 董典宁[1] 金星[1] 

机构地区：[1]山东大学附属省立医院血管外科,济南250021

出　　处：《医学研究杂志》2012年第10期35-37,共3页Journal of Medical Research

基　　金：国家自然科学基金青年科学基金资助项目(81000186)

摘　　要：目的探讨重症下肢深静脉血栓形成后综合征的外科治疗。方法回顾性分析山东大学附属省立医院血管外科自2004年11月～2011年8月收治166例下肢深静脉血栓形成后综合征患者的临床资料,全部采用内镜下穿通静脉离断术联合浅表曲张静脉激光腔内治疗并局部清创和(或)植皮术的手术方式。结果本组患者刀口均一期愈合,平均住院时间为11.3天。46例下肢活动性溃疡于术后平均愈合时间15天。平均随访时间21.3个月,139例患者肢体下肢酸胀沉重症状消失,27例患者肢体症状有不同程度的减轻。12例患者肢体局部出现静脉曲张复发,再次门诊行静脉腔内激光治疗后治愈。结论采用内镜下穿通静脉离断术联合静脉激光腔内治疗重症下肢深静脉血栓形成后综合征,可有效处理小腿穿通静脉及足靴区浅表静脉曲张,并且避免足靴区手术切口并发症,配合清创植皮,临床疗效明显,实现了微创、安全、简单有效的目的,近期随访结果满意。Objective To discuss the surgical treatment for severe post thrombotic syndrome. Methods Retrospective analysis oi 166 cases of severe post thrombotic syndrome hospitalized in department of vascular surgery, Provincial Hospital affiliated to Shandong U- niversity from November 2004 to August 2011 was performed. All patients underwent subfascial endoscopic perforating vein surgery, com- bined with endovenous laser treatment. Debridement and dermepenthesis were also performed on lower extremities with severe skin lesion. Results Operative incisions of 166 cases was primary healing and the average hospital stay was 13.3 days. Active ulcer on lower extremities was healed after sugery and the average healing time was 15 days. The average follow - up was 21.3 months. Swelling of lower extremities disappeared after surgery in 139 patients, and 27 patient were improved obviously. 12 patients presented recurrent symptoms during the fol- low - up and recovered after second endovenous laser treatment. Conclusion Subfascial endoscopic perforating vein surgery combined with endovenous laser treatment is an effective procedure for severe post thrombotic syndrome. The perforating veins and varicose veins of lower extremities are both managed effectively during the procedure, which reduces the incidence of postoperative complications with the help of debridement and dermepenthesis. In conclusion, this procedure is minimally invasive and effective with satisfactory short -term results.

关 键 词：下肢深静脉血栓形成后综合征 内镜下穿通静脉离断术 静脉激光腔内治疗 

分 类 号：R269.544[医药卫生—中西医结合]