短暂阻断血流在严重下肢静脉曲张术中的应用价值

目的 探讨短暂阻断下肢血流在严重下肢静脉曲张手术中的应用价值。方法 180例符合纳入标准的下肢静脉曲张患者被随机分成2组，其中阻断组90例（90条肢体），术中先行大隐静脉高位结扎并将大隐静脉剥至膝下，再使用驱血带和止血带阻断下肢血流，小腿段曲张静脉采用点状切口抽剥术；常规组90例（90条肢体），行大隐静脉高位结扎加曲张静脉点状切口抽剥术，术中不阻断血流。记录下各项观察指标包括手术评价、患者主观评价、患肢评价和影像学评价。结果 阻断组的血流阻断时间为47.77±6.51min。阻断组手术时间(80.51±9.72min)较常规组(100.29±10.03min)明显缩短(p<0.01)，阻断组术中出血量(36.00±16.66ml)较常规组(233.44±81.48ml)明显减少(p<0.01)，阻断组术后血肿评分0(0.15,0.36)]较常规组0.50(0.44,0.71)]明显减少(p<0.01)。术中下肢肿胀、肢体疼痛、患肢感觉情况的差异无显著性。结论 严重下肢静脉曲张抽剥手术中短暂阻断血流能有效减少术中出血和缩短手术时间，且减少了术后皮下血肿的发生，只要严格把握血流阻断时间，能将并发症降低到最低限度。由于止血带和驱血带使用方便且容易取得，该手段仍不失为一种安全有效方法。

Value of interrupt blood flow transiently in the operation of varicose veins of lower limbs

Objective To appraise the value of short lower limbs blocking blood flow in the operation of varicose veins of lower limbs. Methods 180 eligible patients with varicose veins were divided into two groups randomly. In the blocking group, which include ninety patients(ninety limbs), after highly ligate the great saphenous vein, the long saphenous vein was stripped to the level of the knee, then the limbs were exsanguinated and blocked with tourniquet, and spot-striping surger were carried out. In the conventional group, which include ninety(ninety limbs), high level ligation and spot-striping surgery were carried out. The operative assessment, the subjective assessment of patients, the assessment of affected limbs, and the assessment of iconography were recorded. Results In the blocking group, the occlusion time was 47.77±6.51min. Comparing with the conventional group, the duration of operation was greatly shortened (80.51±9.72min) vs (100.29±10.03min)], the intraoperative bleeding volume was significantly reduced (36.00±16.66ml) vs (233.44±81.48ml)], the score of subcutaneous hematoma was significantly reduced 0(0.15,0.36) vs 0.50(0.44,0.71)]. There were no obvious differences among the limb edema, limb pain and numbness. Conclusion In the operation of varicose veins of lower limbs, the use of short lower limbs blocking blood flow could achieve short operative duration, less bleeding and reduce subcutaneous hematoma. Complications can be reduced to a minimum, as long as strict grasp occlusion time. Because the tourniqued and exsanguinations band are easy to use and get, the means is still a safe and effective method.