股浅静脉外瓣膜修复成形术治疗下肢深静脉瓣膜功能不全

为治疗下肢深静脉瓣膜功能不全，作者采用股浅静脉外修复成形术治疗１０例１２条肢体。彩超和静脉造影示１２条肢体深静脉功能不全均在Ⅲ°－Ⅳ°。术后随访全组症状消失，３条肢体溃疡愈合，彩超复查１０条肢体瓣膜功能不全恢复正常，２条Ⅰ°－Ⅱ°。作者认为该术式在术中，术后并发症少，可与浅静脉手术同期进行，手术时间短，操作简便，易于推广使用。     

原发性下肢深静脉瓣膜功能不全的外科治疗

目的评价股浅静脉瓣膜“戴戒”加曲张浅静脉剥脱术治疗原发性下肢深静脉瓣膜功能不全的临床效果。方法回顾性分析我院血管外科1997～2004年收治的78例（92条）原发性下肢深静脉瓣膜功能不全患者实施股浅静脉瓣膜“戴戒”加曲张浅静脉剥脱术的临床疗效。结果65例（76条）术后症状消失或显著改善，恢复满意；8例（10条）术后症状减轻；3例（4条）术后无改善；2例（2条）术后肿胀加剧，经彩超证实为急性髂股静脉血栓形成。患肢治疗临床总有效率为93．5％（86／92），手术并发症发生率为2．2％（2／92）。结论原发性下肢深静脉瓣膜功能不全的外科治疗应严格掌握手术指征，股浅静脉瓣膜“戴戒”加曲张浅静脉剥脱术对重度瓣膜功能不全患者疗效确切、操作简便，是外科治疗的有效术式。     

原发性静脉倒流性疾病的外科治疗

为治疗下肢原发性静脉倒流性疾病,作者采用经皮浅静脉连续环形缝扎术(PCCS)联合大隐静脉高位结扎+抽剥术和下肢深静脉辦膜重建术治疗208例274条肢体,男119例,女89例,平均年龄49.2±3.4岁,平均病程14.0±1.0年。经彩超和静脉顺行造影,有77％患肢有深静脉瓣膜功能不全。术后随访率73.1％,随访平均时间6.5±0.5年。行PCCS+大隐静脉高位结扎+抽剥术的肢体有7.6％浅静脉曲张复发,23.4％症状复发,16.1％溃疡复发,复发病例均为深静脉瓣膜功能不全Ⅱ°以上。行股浅静脉外瓣膜修复成形术者,症状体征全部消失,瓣膜功能恢复正常。PCCS联合大隐静脉高位结扎+抽剥术是治疗下肢浅静脉曲张比较理想的手术方法。深静脉瓣膜功能不全Ⅱ°～Ⅲ°以上者,可同期行股浅静脉外瓣膜修复成形术。     

深静脉瓣膜修复成形术治疗下肢慢性静脉功能不全的随机对照临床研究

目的探讨深静脉瓣膜修复成形术在下肢慢性静脉功能不全治疗中的作用与疗效。方法30例双下肢慢性静脉功能不全的患者接受静脉系统手术治疗。每例2条肢体各采取不同手术方式并随机分组。1条患肢行股浅静脉外瓣膜复成形术加浅静脉手术(A组);另1条患肢仅行浅静脉手术(B组)。术后1个月和3年,利用彩超、流速剖面图彩超技术、空气体积描记仪(APG)和静脉功能不全评分等方法,比较各例2条肢体的疗效以及2组间疗效。结果全组30例患者60条肢体均为CEAP临床分级(Kistner分级)C2～C4级,经彩超和下肢静脉造影证实深静脉瓣膜功能不全返流均为Ⅲ度。术后1个月和3年随访比较,各例属于A组的患肢在静脉返流度、静脉返流量及各项指标均比属于B组患肢改善明显;A组的静脉返流量、静脉灌注指数均值与B组比较差异有统计学意义(P<0.001)。2组的静脉返流度比较差异有统计学意义(P<0.05)。3年随访时2组的射血分数和剩余容量分数均值比较差异有统计学意义(P<0.05);静脉功能不全评分均值比较差异有统计学意义(P<0.001)。结论深静脉瓣膜修复成形术可使下肢深静脉返流量明显减少,瓣膜功能明显恢复,与下肢浅静脉手术联合治疗下肢慢性静脉功能不全有更好的疗效。     

股浅静脉瓣膜外修复成形术后血流动力学动态变化74例分析

目的检测股浅静脉瓣膜外修复成形术后血流动力学动态变化 ,以分析其治疗下肢深静脉瓣膜功能不全的疗效。方法回顾性分析原发性下肢深静脉瓣膜功能不全 74例 ( 96条肢体 )的资料 ,利用流速剖面图彩超和空气体积描记仪分别于术前、术后 1、3个月及 1年进行血流动力学指标检测并进行统计学分析。结果全组术后静脉返流量、灌注指数、静脉功能不全评分指标于术后 1、3个月、1年均较术前显著降低 (P <0 0 1)。而射血分数、剩余容积分数均值于术后 3个月、1年较术前明显改善 (P <0 0 1)。溃疡愈合率达 78 8% ( 2 6 /33) ,术后 93 6 %的肢体各种症状体征消失和明显缓解。结论股浅静脉瓣膜外修复成形术可显著改善血流动力学状况 ,对治疗原发性下肢深静脉瓣膜功能不全及静脉性溃疡有确切疗效     

��֫ԭ���Ծ��������Լ������ۺ����������

目的：探讨下肢原发性静脉返流性疾病的综合外科治疗效果,方法：从1996年2月至2000年9月,对患者肢原发性静脉返流性疾病的108例126条肢体进行了综合性外科手术治疗,所有肢体均行浅静脉手术,83例97条肢体在浅静脉手术同时行股静脉瓣外修复成形成,22例26条同时行股静脉瓣膜外修成形术＋腔镜筋膜下交通静脉结扎术（SEPS）,3例3条同时行SEPS。结果：80．2％（１０１／１２６）的患肢静脉性跛行,酸胀,疼痛等症状消失,１９．８％（２５／１２６）的患肢状明显改善,所有肢体静脉曲线消失,行浅和深静脉系统手术的肢体中有１０条合并溃疡,术后３－６个月,有８条溃疡愈合,２条明显缩小,在浅或（和）深静脉手术基础上加作ＳＥＰＳ的２３例２６条肢体的静脉性溃疡,有２４条术后１４－３2d愈合,２条也明显缩小,全组经彩超复查８９．７％的肢体深静脉瓣膜功能恢复正常,结论：对重度下肢原发性静脉返流性疾病人的浅静脉,深静脉和交通静脉三个系统的疾病变同时综合性的给予外科治疗,可大大提高临床疗效。     

术中超声辅助下腔外瓣膜成形术治疗原发性下肢深静脉瓣膜功能不全

目的探讨术中超声辅助下腔外瓣膜成形术对原发性下肢深静脉瓣膜功能不全（PDVI）的治疗效果和应用价值。方法回顾性分析我院从2004年10月至2009年2月PDVI患者63例（74条肢体）,CEAP分级：C274条肢体,C317条肢体,C436条肢体,c513条肢体,C68条肢体。下肢顺行静脉造影提示深静脉返流Ⅱ～Ⅳ级,浅静脉迂曲扩张。在术中超声辅助下行腔外瓣膜成形术,同时行大隐静脉激光烧灼术及小腿交通静脉点状剥脱术。结果术后所有患者症状全部消失,下肢慢性溃疡者在2～4周愈合,色素沉着逐渐改善。术后6个月进行患肢VCSS评分,表明症状明显缓解,术后6个月复查彩超表明瓣膜成形处直径及返流时间与术前比较差异有统计学意义（P〈0．01）,48例患者术后随访1～5年无复发。结论术中超声辅助下腔外瓣膜成形术治疗PDVI,方法客观,疗效确切。     

血管镜下股浅静脉瓣膜修复成形术12例分析

目的 探讨血管镜直视下股浅静脉壁外瓣膜修复术治疗深静脉瓣膜功能不全的可行性和效果。方法 通过血管镜从大隐静脉断端导入至股浅静脉第1对瓣膜近侧，同时阻断股总、股深、股浅静脉，应用含肝素的冲洗液建立清晰水柱，直接观察瓣膜的形态、缺损和变形的程度，对12例原发性深静脉瓣膜功能不全患者实施直视下壁外静脉瓣膜成形术。结果 12例术后行静脉顺行造影证实9例患肢股浅静脉第1对瓣膜返流基本消失，3例静脉瓣膜返流明显改善，无静脉血栓和其他并发症。结论 血管镜直视下行股浅静脉瓣膜壁外修复术准确有效、微创和安全。     

股浅静脉第一对瓣膜环缩术治疗原发性下肢深静脉瓣膜功能不全(附40例报告)

目的 评估应用股浅静脉第一对瓣膜环缩术治疗原发性下肢深静脉瓣膜功能不全的疗效。方法 对原发性下肢深静脉瓣膜功能不全的40例患者(共45条下肢)施以股浅静脉第一对瓣膜环缩术．环缩材料选用7—0或6—0无损伤缝线。结果 经上述治疗后．全组病例术后随访2～24个月．临床症状均明显缓解。彩超复查88．6％(31／35)的患肢瓣膜无返流发生。结论 股浅静脉第一对瓣膜环缩术是治疗原发性下肢深静脉瓣膜功能不全比较理想和有效的方法。     

彩超辅助下股浅静脉瓣膜环包术治疗原发性下肢深静脉瓣膜功能不全67例体会

目的评价术中彩超辅助下股浅静脉瓣膜环包术治疗原发性下肢深静脉瓣膜功能不全的疗效。方法回顾性分析1998年1月至2005年12月收治的原发性下肢深静脉瓣膜功能不全67例（76条患肢）的临床资料，根据不同时间段将患者分为两组，非彩超辅助组（1998年1月至2000年12月）33例（38条患肢），在股浅静脉和股深静脉汇合处稍远侧找到股浅静脉的第1对瓣膜，用人工血管片缩窄该处血管周径约1／3；彩超辅助组（2001年1月至2005年12月）34例（38条患肢），彩超确定股浅静脉第1对瓣膜的位置及返流程度，人工血管片均匀环包瓣膜，缩窄该处血管周径约1／4～1／3。结果术后1年两组间比较，彩超检查股浅静脉瓣膜返流时间，彩超辅助组≤1S的患肢明显增加，1～6S的患肢明显减少。差异均有统计学意义（P〈0．01；P〈0．05）。X线造影检查股浅静脉瓣膜功能，彩超辅助组患肢0级明显增加；Ⅰ～Ⅲ级明显减少。差异均有统计学意义（P〈0．01；P〈0．05）。结论术中彩超辅助下确定股浅静脉瓣膜的位置、返流程度，从而确定人工血管片环包位置确切、程度恰当。与传统股浅静脉瓣膜环包术比较有明显的优越性。     

瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全47例分析

目的　研究应用股浅静脉瓣膜包窄术治疗下肢深静脉瓣膜功能不全的临床效果 ,总结其手术体会。方法　自体阔筋膜片或人造血管片对 47例下肢深静脉瓣膜功能不全患者施行股浅静脉第一对瓣膜包窄术。结果　 47例手术效果均满意 ,其症状完全或基本消失 ,近期随访无复发。结论　瓣膜包窄术治疗下肢深静脉瓣膜功能不全具有较好的疗效和实用性     

股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全

目的:评估应用股浅静脉第一对瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全的疗效.方法:对原发性下肢深静脉瓣膜功能不全的55例患才施以股浅静脉第一对瓣膜包窄术,包窄材料选用聚四氟乙烯人造血管.结果:本组病人术后均随访4-14个月,术前临床症状缓争,疗效好,结论:股浅静脉第一对瓣膜包窄术治疗瓣膜轻,中度倒流的原发性下肢深静脉瓣膜功能不全,有坚实的理论基础,并有并发症少,操作简单,疗铲好等优点,值得推广.     

��֫�����Ĥ�ؽ�������Ч����

目的分析下肢深静脉瓣膜修复成形术治疗下肢深静脉瓣膜功能不全的临床疗效。方法对下肢原发性深静脉瓣膜功能不全的101例116条肢体实施股静脉瓣膜外修复成形术,并利用静脉功能不全评分、双向彩超、流速剖面图彩超技术和空气体积描记仪(APG)等方法对其疗效进行分析。结果随访率87.9%,随访病例症状消失,96.1%的肢体浅静脉曲张消失无复发。13例溃疡肢体中有11条在术后3～6个月溃疡消失,2条明显缩小。术前Ⅲ度返流肢体术后90%以上静脉瓣膜功能达Ⅱ度以下,67.6%的瓣膜功能恢复正常或接近正常;静脉功能不全评分从术前15.33±1.83改善到术后5.07±0.60(P<0.01);术前Ⅳ度返流肢体术后80%以上静脉瓣膜功能达Ⅱ度以下,40.5%的瓣膜功能恢复正常或接近正常,静脉功能不全评分从术前17.38±2.67改善到术后7.25±1.12(P<0.01)。51例58条肢体经流速剖面图彩超检查示,术后静脉返流量均值比术前明显减少(P<0.01);经APG检测术后VFI均值比术前明显减少(P<0.01)。结论下肢深静脉瓣膜外修复成形术能有效地治疗深静脉瓣膜功能不全,并可大大改善血流动力学指标,对静脉性溃疡也有一定的疗效。     

Ge静脉环缩术治疗严重下肢深静脉倒流性疾病

OBJECTIVE: To study the mechanism and therapeutic effects of annular constriction for severe venous insufficiency of legs. METHODS: Annular constriction of popliteal vein was performed by Gore-Tex vascular graft in 82 patients. Among them, 78 patients had deep venous valve insufficiency of legs (III, IV degree), 2 postphlebitic syndrome, and 2 valve absence of deep vein. Under normal respiration and breath holding, venous pressure was measured at the proximal and distal part from the constricting site. RESULTS: Great difference was noted in the venous pressure between the proximal and distal part from the constricting site. The pressure was (9.4 +/- 4.5) mm Hg, (41.2 +/- 28.1) mm Hg at calm and (32.4 +/- 16.2) mm Hg, (41.2 +/- 28.1)mm Hg at breath holding (P < 0.01). Symptoms disappeared or released after operation. Ulcer healed in all patients. Venous pressure decreased by over 60%. Pressure recovery time was over 22 seconds. There was no reflux distal to the constricting site. Deep venous angiography and color Doppler showed an effect similar to venous valve. CONCLUSION: Annular constriction is effective in treating severe venous insufficiency of legs.     

��֫�����Ĥ�������37�����ƾ���

目的研究下肢深静脉瓣膜外成形术的临床应用价值。方法自2001年1月至2002年10月，四川省人民医院选择经静脉造影或彩色多普勒检查确诊为原发性下肢静脉瓣膜功能不全的37条患肢行静脉瓣膜外成形术。结果31条患肢随访6个月至2年，疗效良好者30条，轻度肿胀1条。经彩色多普勒检查，均无返流。结论深静脉瓣膜外成形术方法简便，不需阻断、切开深静脉，只要操作正确，术后并发症少，是治疗原发性下肢深静脉瓣膜功能不全的首选术式。     

Air plethysmographic assessment of external valvuloplasty in patients with valvular incompetence of the saphenous and deep veins

PURPOSE: The indications for deep venous valvuloplasty remain controversial in patients with incompetent deep vein valves associated with primary varicose veins. The purpose of this study was to evaluate the usefulness of external femoral valvuloplasty performed simultaneously with varicose vein surgery from the standpoint of venous function determined with air plethysmography. PATIENTS AND METHODS: Thirty-one limbs of 25 patients (12 men, 13 women; mean age, 56.3 years; range, 33 to 80 years) with chronic venous insufficiency caused by valvular incompetence of both deep veins and saphenous veins were studied in a prospective, nonrandomized fashion. Descending phlebography showed moderate to severe reflux of grade 3 or 4 with Herman and Kistner classifications. Clinical severity of disease was CEAP classification 2S (in six limbs), classification 3 (in three limbs), classification 4 (in 16 limbs), classification 5 (in two limbs), and classification 6 (in four limbs). We performed superficial venous surgery alone in 14 limbs (control group), which consisted of stripping or ligation of incompetent saphenous veins and ligation of all incompetent perforators. In the remaining 17 limbs (study group), we performed superficial venous surgery simultaneously with external valvuloplasty of the femoral vein with intraoperative endoscopic observation. Venous reflux of the limbs was evaluated with air plethysmographic examination before surgery and at 1, 6, 12, and 24 months after surgery in both groups. RESULTS: Preoperative venous filling index (mean +/- standard deviation) in the control and study groups was 9.4 +/- 3.8 mL/min and 8.8 +/- 3.5 mL/min, respectively (not significant), and it decreased to 7.0 +/- 3.6 mL/min (P <.01) and 2.8 +/- 1.0 mL/min (P <.01), respectively, 1 month after surgery. Postoperative index values in the study group were significantly lower than values in the control group (P <.01), and this difference continued for more than 2 years after surgery (P <.05). After a follow-up period of 12 to 37 months (average, 25 months), the venous clinical severity score was higher in the control group (3.4 +/- 1.7) than in the study group (2.1 +/- 0.3; P <.05), and the venous disability score was higher in the control group (1.4 +/- 0.6) than in the study group (0.8 +/- 0.8; P <.05). CONCLUSION: Although further follow-up study is necessary, these results point to the functional and clinical usefulness of femoral valvuloplasty performed simultaneously with varicose vein surgery in patients with moderate to severe deep venous reflux. The venous filling index obtained with air plethysmography is an excellent predictor of the clinical severity of the disease and of postoperative clinical results.     

Results of Valvuloplasty in Patients Presenting Deep Venous Insufficiency and Recurring Ulceration

The purpose of this retrospective study was to assess mid-term results of valvuloplasty in patients presenting chronic recurring venous stasis ulceration. From 1988 to 1993, valvuloplasty was performed in the superficial femoral vein of 33 lower extremities in 28 patients presenting recurring ulceration. In 23 cases, previous surgery in the superficial venous system or perforating vein had failed. Preoperative work-up demonstrated primary deep venous insufficiency (PDVI) in 22 extremities (group I), proximal PDVI in association with distal postthrombotic syndrome (PTS) in 10 (group II), and Klippel-Trenaunay syndrome in 1. Hemodynamic assessment with tourniquet placement demonstrated a mean venous return time of 9 sec (+10, -8). Descending femoral phlebography showed Kistner grade 4 in 30 cases. Outcome was evaluated by clinical examination and Dupplex scan with photophlethysmography at follow-up times ranging from 2 to 7.6 years (mean: 51 months). Correlation between outcome of valvuloplasty and clinical findings was excellent. The incidence of poor clinical and hemodynamic results was higher for patients with PTS. Valve repair in association with surgery for superficial vein insufficiency and ligation of perforators gives good results in patients with isolated PDVI.     

戴戒术与单纯浅静脉剥脱术治疗原发性下肢深静脉瓣膜功能不全的比较

目的:比较股浅静脉戴戒术与单纯性浅静脉剥脱术治疗下肢深静脉瓣膜功能不全的疗效。方法:将2010年03月—2011年1月收治的48例下肢深静脉瓣膜功能不全伴静脉曲张患者随机分为观察组(股浅静脉戴戒术联合大隐静脉高位结扎剥脱术)和对照组(传统大隐静脉高位结扎剥脱术),通过彩色多普勒检测两组术前及术后股总静脉血管内径、平均血流速度及Valsalva试验下反流持续时间的变化。结果:与术前比较,术后两组患者的静脉瓣膜功能及血流动力学均明显改善,表现为股总静脉管径缩小、平均血流速度增快、静脉血流反流时间缩短(均P<0.05),但观察组上述3个变量手术前后变化程度(差值)均明显大于照组(均P<0.05)。结论:两种手术方式均是治疗下肢深静脉瓣膜功能不全的有效手段,但戴戒术的治疗效果优于单纯性浅静脉剥脱术。