下肢浅静脉曲张手术对深静脉瓣膜功能影响的临床研究  

Influence of surgery for superficial varicose veins on function of deep venous valves in lower extremities

作　　者：邱天[1] 郭曙光[1] 方伟[1] 周兴立[1] 彭明生[1] 尹存平[1] 张鹏[1] 苏宏斌[1] 张铠[1] 

机构地区：[1]成都军区昆明总医院血管外科,云南昆明650032

出　　处：《中国普通外科杂志》2015年第6期852-856,共5页China Journal of General Surgery

摘　　要：目的：探讨原发性下肢深静脉瓣膜功能不全（PDVI）患者行下肢浅静脉曲张手术对深静脉瓣膜功能的影响。方法：回顾性分析94例行下肢浅静脉曲张手术的PDVI患者（95条肢体）资料,比较患者手术前后深静脉瓣膜功能的变化。结果：术前经彩色多普勒超声检查明确95条肢体均存在PDVI,按CEAP分级,C2级31条、C3级22条、C4级25条、C5级7条、C6级10条。术后半年复查彩色多普勒超声显示,40条肢体（42.1%）瓣膜功能恢复正常、21条肢体（22.1%）脉瓣膜功能改善、23条肢体（24.2%）无法判断、11条肢体（11.6%）瓣膜功能不全加重,加重的肢体中10条术前CEAP分级为C5~6级;95条肢体术后平均反流持续时间（VCT）与峰值流速（Vmax）均较术前明显降低（均P〈0.05）。结论：PDVI患者行下肢浅静脉曲张手术能在一定程度上改善深静脉瓣膜功能,但是对于C5~6级患者,由于瓣膜功能破坏较严重,建议同时行深静脉瓣膜修复手术。Objective： To investigate the impact of operation for lower extremity superficial varicose veins on function of deep venous valves in patients with primary deep vein valvular incompetence（PDVI）.Methods： The clinical data of 94 PDVI patients（95 limbs） undergoing surgery for superi cial varicose veins of the lower extremity were retrospectively analyzed. The changes in deep venous valve function before and after operation were compared.Results： All the 95 limbs were dei nitely diagnosed to have PDVI by color Doppler ultrasonography before operation, in which according to CEAP classification, 31 limbs were classified as C2, 22 were C3, 25 were C4, 7 were C5, and 10 were C6, respectively. Results of color Doppler ultrasonography half a year after operation showed that valvular function returned to normal in 40 limbs（42.1%）, improved in 21 limbs（22.1%）, was unableto be determined in 23 limbs（24.2%）, and the valvular incompetence was aggravated in 11 limbs（11.6%）, 10 of which were classified as C5–6 by preoperative CEAP classification; the average valve closure time（VCT） and maximum velocity（Vmax） of the 95 limbs were all significantly decreased compared with preoperative values（both P0.05）.Conclusion： The valvular function of deep veins in PDVI patients may be improved to some extent after operation for lower extremity supericial varicose veins. However, for patients with C5–6 classification, the synchronous repair of deep vein valves is recommended because of the serious damage of their valvular function.

关 键 词：静脉功能不全 静脉曲张 下肢 超声检查 多普勒 彩色 

分 类 号：R654.3[医药卫生—外科学]