精准瓣膜外修复成形术治疗难治性下肢深静脉瓣膜功能不全的临床研究  

Clinical study of precise deep venous valve repair in the treatment of refractory lower extremity deep venous valve insufficiency

作　　者：李全成[1] 苏少飞[1] 闫波[1] 田玉峰[1] 伍卫东 李辉 LI Quancheng;SU Shaofei;YAN Bo;TIAN Yufeng;WU Weidong;LI Hui(Department of Vascular Surgery,First People's Hospital of Yinchuan,Yinchuan 750001,China)

机构地区：[1]宁夏银川市第一人民医院血管外科,宁夏银川750001

出　　处：《宁夏医学杂志》2021年第9期785-788,F0003,共5页Ningxia Medical Journal

基　　金：宁夏科技厅重点研发计划项目(2020BEG03049);宁夏医科大学校级科研资助项目(XM2019160)。

摘　　要：目的探讨精准瓣膜外修复成形术治疗难治性下肢深静脉瓣膜功能不全的临床应用。方法难治性下肢深静脉瓣膜功能不全患者120例,根据经济能力和自愿的原则分为治疗组和对照组,每组60例。治疗组行精准深静脉瓣膜外(股浅静脉第1对、第2对或腘静脉等)修复成形术+大隐静脉高位结扎微创剥脱+交通支静脉结扎术;对照组行大隐静脉高位结扎微创剥脱+交通支静脉结扎术。记录2组患者术后6个月临床表现变化和临床严重程度评分(VCSS)变化数据,采用下肢静脉彩超检查评估静脉瓣膜返流时间,分析患者术前和术后静脉瓣膜返流时间;采用生活质量量表(CIVIQ-20)评分进行患者生活质量调查。结果2组患者术前、术后肿胀消退率、色素沉着改善率、静脉性跛行改善率、溃疡愈合率、VCSS评分对比,治疗组优于对照组(P<0.05);2组患者术前、术后6个月静脉瓣膜返流时间和生活质量调查CIVIQ评分,治疗组优于对照组(P<0.05)。2组患者术前患侧足背静脉压P0、Pmin、RT90差异无统计学意义(P>0.05),术后12 d、6个月患侧足背静脉压P0、Pmin、RT90治疗组均优于对照组(P<0.05)。结论精准判断返流瓣膜部位,对返流瓣膜行深静脉瓣膜外修复成形对下肢静脉倒流性疾病,特别是难治性下肢深静脉瓣膜功能不全患者治疗,临床效果好。Objective To study the clinical application of precise deep venous valve repair in the treatment of refractory lower extremity deep venous valve insufficiency.Methods A total of 120 patients with refractory deep venous insufficiency of lower extremity were enrolled in this study.The patients were divided into treatment group(n=60)and control group(n=60)according to the principle of economic ability and voluntariness.The treatment group was treated with precise deep vein valve repair(such as the first pair of superficial femoral vein,the second pair or popliteal vein,etc.),and minimally invasive stripping of great saphenous vein high ligation,and ligation of communicating branch vein;The control group was treated with high ligation and minimally invasive stripping of great saphenous vein and ligation of communicating branch vein.The changes of clinical manifestations(swelling subsided,pigmentation improved,venous claudication improved,ulcer healing)and clinical severity score(VCSS)were recorded after operation for next 6 months.Venous valve regurgitation time was evaluated by color doppler ultrasound of lower extremity,and venous valve reflux time before and after operation was analyzed.The quality of life was investigated by civiq-20.Results The swelling subsided rate,pigmentation improvement rate,venous claudication improvement rate,ulcer healing rate and VCSs scores in treatment group had obvious advantages than that in control group(P<0.05).Compared with control group,CIVIQ score before and 6 months after operation were higher in treatment group(P<0.05).There was no significant difference in P0,Pmin,RT90 of the preoperative dorsal venous pressure before surgery between the two groups(P>0.05).However,there were significant advantages in the treatment group in the 12 days and 6 months after operation(P<0.05).Conclusion Accurately judging the position of the regurgitant valve,and performing deep venous extravalvular repair of the regurgitant valve has a good clinical effect on patients with venous reflux disease

关 键 词：精准瓣膜外修复成形术 深静脉瓣膜功能不全 下肢 静脉压 

分 类 号：R654.4[医药卫生—外科学]