精准瓣膜外修复成形术治疗原发性下肢深静脉瓣膜功能不全的远期疗效观察  

Clinical Study on the Long-term Effect of Precise External Valvuloplasty in the Treatment of Primary Deep Venous Valve Insufficiency of Lower Extremities

作　　者：李全成[1] 马丽[1] 苏少飞[1] 田玉峰[1] 杜丽娜 刘勇 伍卫东 闫波[1] LI Quancheng;MA Li;SU Shaofei;TIAN Yufeng;DU Lina;LIU Yong;WU Weidong;YAN Bo(Department of Vascular Surgery,The First People’s Hospital of Yinchuan,the Second Clinical Medical College of Ningxia Medical University,Yinchuan 750001,China;Ningxia Hui Autonomous Region Corps Hospital,Chinese People s Armed Police Force,Yinchuan 750004,China)

机构地区：[1]银川市第一人民院血管外科,宁夏医科大学第二临床医学院,银川750001 [2]中国人民武装警察部队宁夏总队医院外三科,银川750004

出　　处：《宁夏医科大学学报》2025年第2期156-160,共5页Journal of Ningxia Medical University

摘　　要：目的探讨精准瓣膜外修复成形术治疗原发性下肢深静脉瓣膜功能不全的远期临床疗效。方法原发性下肢深静脉瓣膜功能不全患者120例,根据随机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(如股浅静脉第1对、第2对或腘静脉等)修复成形术+大隐静脉高位结扎剥脱+交通支静脉结扎术;对照组行大隐静脉高位结扎剥脱+交通支静脉结扎术。记录两组患者术后2年临床表现变化和静脉临床严重程度评分(VCSS)变化数据;采用彩超检查下肢静脉来评估瓣膜反流时间,分析患者术前和术后静脉瓣膜反流时间;采用生活质量量表(CIVIQ-20)评分进行患者生活质量调查。结果两组患者术后肿胀消退率、静脉性跛行改善率、色素沉着改善率、溃疡愈合率、VCSS评分对比,治疗组均优于对照组(P均<0.05);两组患者术后2年静脉瓣膜反流时间和生活质量调查CIVIQ-20评分比较,治疗组均优于对照组(P均<0.05)。患者术后12 d、6个月、2年患侧足背运动后最低静脉压(Pmin)、最低静脉压回升至90%静息压的时间(RT90)比较,治疗组均优于对照组(P均<0.05)。结论精准判断反流瓣膜部位,对反流瓣膜行深静脉瓣膜外修复成形术对原发性下肢深静脉瓣膜功能不全患者远期临床效果好,值得向基层推广。Objective To explore the long-term clinical efficacy of precise external valvuloplasty in the treatment of primary lower extremities venous valve insufficiency.Methods A total of 120 patients with lower extremity deep vein valve insufficiency were enrolled and divided into the treatment group and the control group according to the principle of randomness,with 60 cases in each group.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.)plus minimally invasive stripping of great saphenous vein high ligation plus 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 and venous clinical severity score(VCSS)were recorded two years after operation.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 After operation,the swelling subsided rate,pigmentation improvement rate,venous claudication improvement rate,ulcer healing rate and VCSS score of the two groups were compared,and the treatment group had obvious advantages(P all<0.05).Compared with CIVIQ score of the two groups 2 years after operation,the advantages of the treatment group were significant(P all<0.05).At 12 days,6 months,and 2 years after surgery,Pmin and RT90 values of the dorsal vein pressure on the affected side of the foot in the treatment group were all better than those in the control group(P all<0.05).Conclusion Accurately identifying the location of the reflux valve and performing deep vein valve repair and shaping on the reflux valve for the treatment of patients with primary lower limb deep vein valve dysfunction has good long-term clinical effects and is worth promoting to the grassroots level.

关 键 词：瓣膜外修复成形术 下肢 深静脉瓣膜功能不全 远期疗效 静脉压 

分 类 号：R543[医药卫生—心血管疾病]