大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗下肢深静脉瓣膜功能不全的临床疗效  

Effects of high ligation and stripping of great saphenous vein combined with ringing of superficial femoral vein on patients with lower extremity deep vein valve insufficiency

作　　者：吴曹 耿家威 王浩然 刘齐 WU Cao;GENG Jia-wei;WANG Hao-ran;LIU Qi(Department of Vascular Surgery,Fuyang Hospital Affiliated to Bengbu Medical College,Fuyang Anhui 236000,China;Department of Vascular Surgery,First Affiliated Hospital of Anhui Medical University,Hefei Anhui 230022,China)

机构地区：[1]蚌埠医学院附属阜阳医院血管外科,安徽阜阳236000 [2]安徽医科大学第一附属医院血管外科,安徽合肥230022

出　　处：《局解手术学杂志》2020年第7期568-572,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：安徽省卫生和计划生育委员会科研计划项目(2016QK1015)。

摘　　要：目的探讨大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗下肢深静脉瓣膜功能不全(DVVI)的临床疗效。方法回顾性分析2016年1月至2017年10月蚌埠医学院附属阜阳医院收治的457例下肢DVVI患者的临床资料,根据手术方式的不同分为观察组(236例)和对照组(221例)。观察组患者行大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗,对照组患者仅行大隐静脉高位结扎剥脱术治疗。通过彩色多普勒超声检查分析患者术后2周、2年的静脉管径值、平均血流速度及Valsalva试验下血液反流持续时间,利用单因素和多因素Logistic回归分析DVVI患者术后复发的危险因素。结果术后2周观察组患者静脉管径值和反流持续时间均短于对照组,平均血流速度则高于对照组,差异有统计学意义(P<0.05);术后2年观察组患者平均血流速度高于对照组,而静脉管径值和反流持续时间短于对照组,差异有统计学意义(P<0.05)。观察组复发率为6.36%,低于对照组的15.84%,差异有统计学意义(P<0.05)。经单因素分析,复发与患者年龄、术前CEAP分级、穿戴TED弹力袜时间、阿司匹林肠溶片依从性、GSV属支残留和股浅静脉带戒术有关(P<0.05)。多因素Logistic回归分析显示,年龄≥50岁(OR=5.953)和GSV属支残留(OR=12.167)是术后复发的独立危险因素(P<0.05),而股浅静脉带戒术是术后复发的独立保护因素(OR=0.728,P<0.05)。结论大隐静脉高位结扎剥脱术联合股浅静脉带戒术治疗下肢DVVI的疗效显著,在改善患者血流动力学方面更具优势,复发率更低。Objective To investigate the clinical effects of high ligation and stripping of great saphenous vein combined with ringing of superficial femoral vein on patients with deep vein valve insufficiency(DVVI)of lower extremity.Methods The clinical data of 457 patients with DVVI of lower extremity admitted to Fuyang Hospital Affiliated to Bengbu Medical College from January 2016 to October 2017 were analyzed retrospectively,the patients were divided into the observation group(n=236)and the control group(n=221)according to the surgical methods.Patients in the observation group underwent high ligation and stripping of great saphenous vein combined with ringing of superficial femoral vein,and patients in the control group underwent high ligation and stripping of great saphenous vein only.The diameter of vein,the mean velocity of blood flow and the duration of blood regurgitation under Valsalva test were analyzed by color doppler examination at 2 weeks after operation and 2 years after surgery.Risk factors for postoperative recurrence of DVVI were analyzed by univariate analysis and multivariate Logistic regression analysis.Results The diameter of vein and the duration of blood regurgitation in the observation group were smaller or less than those in the control group,but the mean blood flow velocity was higher than that in the control group at 2 weeks after the operation(P<0.05).The mean blood flow velocity of the observation group was higher than that of the control group,while the diameter of vein and the duration of blood regurgitation were smaller or less than those of the control group 2 years later(P<0.05).The recurrence rate of the observation group was 6.36%which lower than 15.84%of the control group(P<0.05).Univariate analysis showed that recurrence would be related with age,CEAP grade,time of wearing TED stretch socks,compliance of Aspirin enteric-coated tablets,GSV residues and ringing of superficial femoral vein(P<0.05).The multivariate Logistic regression analysis showed that age≥50 years(OR=5.953)and GSV r

关 键 词：股浅静脉带戒术 大隐静脉高位结扎剥脱术 下肢深静脉瓣膜功能不全 血流动力学 

分 类 号：R543.6[医药卫生—心血管疾病]