老年原发性下肢深静脉瓣膜功能不全52例误漏诊情况与治疗结果分析  

Analysis of Causes and Treatment Outcomes of 52 Elderly Misdiagnosed Patients with Primary Deep Venous Insufficiency

作　　者：武欣[1] 张海军 齐立行[1] 李学峰[1] 郭连瑞[1] 张建[1] 汪忠镐[1] 谷涌泉[1] 

机构地区：[1]首都医科大学附属宣武医院血管外科研究所,北京100053 [2]宁城县医院血管外科,内蒙古自治区宁城024200

出　　处：《临床误诊误治》2014年第3期77-80,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家高技术研究发展计划"863"项目(2012AA020507)

摘　　要：目的 探讨老年患者原发性下肢深静脉瓣膜功能不全（primary deep vein insufficiency,PDVI）的误诊原因,总结治疗经验.方法 回顾性分析52例老年PDVI误诊病例的临床资料.结果 52例均有程度不一的患肢发胀、沉重感或胀痛,易疲劳、乏力;部分伴小腿肌肉痉挛发作、迂曲浅静脉团、踝部及足背轻微水肿、足靴区皮肤营养障碍性改变及色素沉着.本组30例（57.7％）仅诊为单纯大隐静脉曲张,漏诊PDVI,其中16例在外院行大隐静脉高位结扎和剥脱术,8例术后1～5年静脉曲张复发;12例（23.1％）误诊为轻度肾功能不全;10例（19.2％）误诊为腰椎间盘突出症.本组52例均经无创Doppler检查,Valsalva试验逆向血流持续时间＞0.5 s,确诊为PDVI.予药物治疗并辅以弹力袜治疗为主,平均随访6个月,大部分患者症状明显改善.结论 加强对PDVI的认识,重视老年患者临床表现,可减少误诊漏诊发生.Objective To explore the causes of misdiagnosed elderly patients with primary deep venous insufficiency （PDVI） and to summarize the experiences. Methods Clinical data of 52 elderly patients with PDVI was retrospectively ana- lyzed. Results All the patients had different degrees of affected limb tumescence, heaviness or gas pains, fatiguability and acratia; some patients had muscle spasm in legs, varicose veins, little edema in ankle and dorsi pedis, disordered changes of skin nutrition and pigmentation in ankle area. In the 52 patients, 30 patients （57.7%） were misdiagnosed as having simple great saphenous varicose veins, including 16 missed diagnosis patients had undergone high ligation and stripping surgery of great saphenous vein in other hospitals, and 8 patients had recurred varicose veins during postoperative 1 to 5 years; 12 pa- tients （23.1% ） were misdiagnosed as having mild renal insufficiency; 10 patients （ 19.2% ） were misdiagnosed as having lubar intervertebral disc protrusion. PDVI was confirmed in the 52 patients by noninvasive Doppler examination and more than 0.5 s converse blood stream of duration in Valsalva test. Symptoms obviously improved in most patients after drug therapy combined with compression stockings therapy with 6 months of follow-up on average. Conclusion Rates of missed diagnosis and misdiag- nosis can be reduced by enhancing PDVI understanding, and paying more attention to elderly patients＂ clinical manifestations.

关 键 词：静脉功能不全 下肢 误诊 静脉曲张 椎间盘移位 

分 类 号：R654.4[医药卫生—外科学]