白细胞激活-慢性静脉功能不全发病机制的近代观念(文献综述)

慢性静脉功能不全的病因及病理机制复杂,近年来白细胞激活受到重视,在静脉重塑及静脉性溃疡中有重要作用.     

白细胞激活-慢性静脉功能不全发病机制的近代观念（文献综述）

慢性静脉功能不全的病因及病理机制复杂，近年来白细胞激活受到重视，在静脉重塑及静脉性溃疡中有重要作用。     

下肢慢性静脉功能不全与炎症反应及细胞免疫

下肢慢性静脉功能不全(chronic venous insufficiency of low limbs，CVI)是最常见的周围血管疾病，以下肢静脉压增高为主要的血流动力学改变。CVI病因和病理机制的早期研究，注重于静脉高压、小腿肌泵功能减退与静脉曲张、静脉溃疡的关系。静脉瓣膜功能不全是导致静脉血重力性返流的主导原因，在小腿肌泵收缩期后，腓肠肌静脉丛再充盈时间缩短，引起小腿深静脉和浅静脉内压力持续增高。     

外科手术在治疗慢性静脉功能不全中的作用

下肢慢性静脉功能不全（chronic venous insufficiency,CVI）是外科临床的常见病和多发病,我国的发病率约为8％-13％。按1995年American Venous Forum所认同的概念及诊断和分类标准,多种血管疾病均可导致CVI的发生。按病因可分为原发性、继发性和先天性;按血流动力学可分为血液反流性病变和血液回流障碍性病变;按解剖学可涉及浅静脉、深静脉和交通静脉三个系统。外科手术主要针对原发性、血液反流性疾病,范围可涵盖浅静脉、深静脉和交通静脉。     

白细胞激活在下肢静脉性溃疡发病机制中的作用

慢性静脉性溃疡是慢性静脉功能不全(chronic venous insufficiency,CVI)最严重的并发症.在欧美国家,住院患者中静脉性溃疡发病率为1％～1.5％,总花费占年度卫生总预算的1％[1].我国的静脉疾病发病率既往要比西方国家低,静脉性溃疡的发病率在人群中约为0.4％～1.3％[2].但近年来有快速上升的趋势,因此静脉疾病的病因学研究就显得越来越重要.     

小腿交通静脉功能不全与慢性静脉功能不全相关性的研究

目的探讨交通静脉功能不全(IPV)中功能不全交通静脉的分布及其在慢性静脉功能不全(CVI)过程中的角色。方法 46例确诊为CVI患者,临床症状:有坠胀感35例,无坠胀感11例,伴有皮肤瘙痒24例,无皮肤瘙痒22例,有夜间抽筋症状6例,无夜间抽筋40例。46例患者(46条肢体)CEAP分期:C2(19例)、C3(6例)、C4a(11例)、C4b(5例)、C5(3例)、C6(2例)。用多普勒超声定位IPV,测量交通静脉到足底的距离,以大、小隐静脉主干进行内外分区,将小腿分为三段、共八个区段进行记录,数据进行统计分析。结果共记录305个功能不全交通静脉,其中大隐静脉内上(19个)、大隐静脉内中(62个)、大隐静脉内下(34个)、小隐静脉外上(17个)、小隐静脉外中(52个)、小隐静脉外下(6个)、大隐静脉主干(64个)、小隐静脉主干(51个)。小隐静脉外上区段的交通静脉与抽筋,小隐静脉外中区段的交通静脉与CEAP-C分期、皮肤瘙痒,大隐静脉主干区段的交通静脉与抽筋间的关系具有统计学意义(P≤0.05)。结论功能不全交通静脉主要分布于小腿中段及大小隐静脉主干,且与CVI的临床症状相关。     

中西医结合治疗下肢慢性静脉功能不全性溃疡

目的：探讨下肢慢性静脉功能不全性溃疡的中西医结合治疗方法。方法：将60例患者分为治疗组和对照组各30例,对照组采用大隐静脉高位结扎、剥脱加交通支结扎术,治疗组在手术基础上内服中药,观察术后2周肢体肿胀及创面改善情况,比较溃疡完全愈合时间。结果：两组均无切口感染,术后2周肢体肿胀情况治疗组优于对照组,治疗组创面完全愈合时间为9～61d,平均（20.37±7.53）d。结论：手术联合中药是治疗下肢慢性静脉功能不全所致静脉性溃疡的理想方法。     

静脉高压对慢性静脉功能不全患者血小板活性的影响

目的 观察体位变化和压力对下肢慢性静脉功能不全(CVI)患者血小板活性的影响.方法 根据纳入和排除标准,选择24例CVI患者作为实验组和20例正常人作为对照组,采用酶联免疫吸附法(ELISA)测定两组人群在不同体位时下肢静脉血液、肘部静脉血液及在外在压力持续作用60 min后血小板P-选择素表达水平.结果 晨起平卧位及站立30 min后两组下肢静脉血液血小板P-选择素表达水平差异无统计学意义(P>0.05);在90～100mm Hg(1 mmHg=0.133 kPa)压力作用60 min后,CVI患者的下肢静脉血液和肘部静脉血液血小板P-选择素均明显高于对照组(P<0.01).结论 CVI患者血小板对压力具有高反应性,可能是CVI发病的重要机制之一.     

内镜静脉交通支离断术治疗慢性下肢静脉功能不全

下肢静脉溃疡（venous leg ulcera-tion,VLU）是下肢慢性静脉功能不全（chronic venous insufficiency,CVI）最严重的并发症,临床较常见,往往经久不愈或反复发作,极大影响患者生活质量。VLU占CVI的10%,目前认为深静脉瓣膜功能不全引起的静脉高压是VLU的主要原因。     

进一步提高我国下肢静脉瓣膜功能不全的治疗水平

慢性下肢静脉功能不全（chronic venous insufficiency of the lower extremity,CVI）是一种常见病、多发病，下肢静脉曲张又是其常见的临床表现。外科医师，特别是血管外科同道们对这一疾病已有了较深入地认识。随着认识的逐步加深，治疗水平也在逐步提高，国际上已开展的治疗CVI的各种术式在国内均已开展，尤其是腔外瓣膜成形术的应用更为广泛，这些临床实践和经验的积累正在推动着我国静脉外科的迅速发展。     

Venous Stasis Ulcers Due to Primary,Isolated Deep Venous Insufficiency in a Patient with Systemic Lupus Erythematosus: Report of a Case

Primary, isolated deep venous incompetence is rare, difficult to diagnose, and can lead to the development of venous stasis ulcers. We herein report a case demonstrating chronic venous stasis ulcers due to primary, isolated deep venous incompetence, which was misdiagnosed as vasculitis ulcers associated with systemic lupus erythematosus (SLE). Although primary, isolated deep venous incompetence is rare, it is important to bear this possibility in mind when a patient presents with leg ulcers. Received: September 12, 2001 / Accepted: March 5, 2002     

腔镜筋膜下交通静脉离断术治疗下肢慢性静脉功能不全

目的:探讨腔镜筋膜下交通支静脉离断术在治疗下肢慢性静脉功能不全中的作用。方法:选取CEAP分级C4级以上的患者22例(共27条肢体)行腔镜深筋膜下交通静脉离断术,并联合施行大隐静脉及曲张浅静脉剥脱术。结果:22例术后症状和浅静脉曲张消失,无切口感染坏死、皮下气肿及筋膜腔血肿等并发症。足靴区色素沉着及硬化明显改善,6例足靴区活动性溃疡在术后2周内愈合。随访1~12个月无静脉曲张及溃疡复发。结论:腔镜深筋膜下交通静脉离断术具有交通支静脉离断彻底、损伤小、恢复快、复发率低、并发症少等优点,可作为治疗CEAP分级Ap、PR的CVI患者的重要手段。     

The Predictive Value of Haemodynamic Assessment in Chronic Venous Leg Ulceration

OBJECTIVES: The aim of this study was to assess the value of PPG in predicting healing and recurrence in patients with chronic venous ulceration. METHODS: 500 patients with open or recently healed venous ulceration were treated with either multilayer compression or compression plus superficial venous surgery and followed up in specialist clinics as part of a clinical study. At initial assessment, VRT was measured using PPG with and without a below-knee tourniquet inflated to 80 mmHg to occlude superficial veins. Legs were stratified into groups with VRT <11s, 11-20s and >20s and comparison of healing and recurrence rates between these groups was performed. RESULTS: VRT measurements were not achieved in 117 patients, primarily due to ankle stiffness. Of the remaining 383 patients, VRT without tourniquet did not correlate with ulcer healing (p=0.26, 0.40) or recurrence (p=0.20, 0.79, Log rank test) for legs treated with compression or compression plus surgery respectively. However, VRT readings taken with a below-knee tourniquet were predictive of ulcer healing (p<0.01) and recurrence (p=0.05, Log-rank test). The correlation was greatest for healing in legs treated with compression alone, where 24 week healing rates were 62%, 73% and 92% for legs with VRTs with tourniquet <11s, 11-20s and >20s respectively (p<0.01, Log rank test). For legs treated with surgery, 1 year recurrence rates were 24%, 10% and 3% for groups with VRTs with tourniquet <11s, 11-20s and >20s respectively (p=0.03, Log rank test). CONCLUSIONS: Digital PPG assessment may predict ulcer healing and recurrence, but only by using a below-knee tourniquet. This information could aid the selection of patients with venous ulceration most likely to benefit from superficial venous surgery.     

下肢原发性静脉返流性疾病的外科治疗进展

目的：探讨下肢原发性静脉返流性疾病的外科治疗效果。方法：对国外有关下肢静脉返流性疾病外科治疗方面的文献进行综述。结果：下肢慢性静脉功能不全常常累及下肢多个静脉系统，对下肢浅静脉、深静脉和交通静脉三个系统同时进行治疗，才能取得更好的临床疗效。结论：对各个下肢静脉系统进行综合性治疗，将成为今后外科治疗下肢慢性静脉疾病的方向。