内镜深筋膜下交通支静脉结扎治疗下肢慢性溃疡

目的 :探讨内镜深筋膜下结扎交通支静脉治疗下肢慢性溃疡的效果。方法 :手术治疗 14例下肢慢性静脉性溃疡 ,同时存在不同程度浅静脉倒流、交通支静脉功能不全、深静脉瓣膜功能不全。手术方式为内镜深筋膜下交通支静脉结扎、大隐静脉高位结扎并抽剥和小腿曲张浅静脉经皮连续环形缝扎术 ,其中 10例同时行血管镜下股浅静脉壁外瓣膜修复成形术。结果 :术后患肢症状和浅静脉曲张消失 ,14例静脉性溃疡短期内愈合。结论 :内镜深筋膜下交通支静脉结扎术安全有效 ,结扎完全、确切 ,较高位损伤小 ,并发症少 ,是治疗下肢静脉功能不全性溃疡的有效方法和主要组成部分     

下肢深静脉倒流性功能不全和瓣膜功能定位检测

作者倡用一种新的下肢深静脉造影术,即经皮腘静脉插管造影方法。在腘窝部穿刺腘静脉,向近侧插入导管作造影检查,非但可以清晰地显示髂-股-腘静脉,更能逐一测试这段静脉中每一对瓣的功能,弥补了顺行和逆行造影术的不足。根据本研究资料,对发病机理、诊断及治疗方法等提出了新的观点和指导原则,并已在临床得到验证。     

腔镜下静脉交通支离断术治疗下肢静脉交通支瓣膜功能不全(附17例分析)

目的:探讨腔镜下静脉交通支离断术(SEPS)治疗下肢静脉交通支瓣膜功能不全的可行性。方法:2007年4月-2008年12月,经静脉造影诊断下肢静脉交通支瓣膜功能不全患肢17条,行SEPS术在深筋膜下断离病变交通支,联合Muller术抽剥浅表静脉以及行传统大隐静脉高位结扎+抽剥术。结果:17条患肢术后创口生长良好,无感染及出血,术后所有患肢曲张静脉团消失,局部疼痛缓解,7条患肢内踝沉着色素减轻,5条患肢溃疡在2~4周内完全愈合,无溃疡复发及新溃疡形成,术后无组织水肿。结论:腔镜下静脉交通支离断术(SEPS)治疗下肢静脉交通支瓣膜功能不全、下肢静脉溃疡具有创伤小、手术彻底、患者住院时间短的优点。     

微创刨吸术治疗下肢静脉曲张初步研究

目的探讨微创刨吸术治疗下肢静脉曲张的初步疗效.方法对2003年6～9月40例(53条肢体)下肢静脉曲张病人进行手术治疗.53条患肢均存在浅静脉曲张,16条患肢同时伴交通支静脉功能不全,10条患肢同时伴慢性静脉性溃疡,5条患肢同时伴重度深静脉返流.根据病情需要分别或同时行内镜深筋膜下交通支静脉结扎、大隐静脉高位结扎和剥脱飞股浅静脉瓣膜外修复成形术和下肢曲张浅静脉微创刨吸术.结果术后53条患肢肢体症状和浅静脉曲张消失,10条患慢性静脉性溃疡肢体短期内愈合.术后短期随访,无新生的渍疡,无静脉曲张复发,小腿外观无明显手术疤痕.结论微创刨吸术治疗下肢静脉曲张安全有效,损伤少,并发症少,达到了微创和显效的目的,可能是治疗下肢慢性静脉功能不全的重要组成部分.     

静脉腔内激光在下肢静脉性溃疡中的应用

目的探讨下肢静脉溃疡行静脉腔内激光治疗的效果。方法通过顺行下肢深静脉造影明确引起溃疡的病因,继而对34例(35条)下肢静脉溃疡采用静脉腔内激光+大隐静脉高位结扎+膝上大隐静脉主干抽剥术进行治疗,左髂总静脉球扩4例,溃疡处植皮2例。结果术后下肢静脉曲张均消失,溃疡6~45 d愈合。随访28例,时间4~56个月,1例复发。结论消除下肢浅静脉的淤积和反流是治疗下肢静脉性溃疡的关键。静脉腔内治疗不仅可有效消除浅静脉曲张,还可运用合适的方法闭合交通支静脉,防止复发。     

下肢静脉性溃疡的联合微创治疗

探讨腔内激光闭合术结合聚桂醇泡沫硬化剂曲张静脉注射、穿静脉结扎治疗下肢静脉性溃疡的疗效。方法下肢静脉性溃疡45例63肢,全部在硬膜外麻醉下行高位结扎大隐静脉主干及其属支,激光闭合大隐静脉主干;泡沫硬化剂栓塞曲张侧枝静脉团块;穿静脉特别是Cockett穿通支点状离断。结果随访3～12个月,所有患肢溃疡全部愈合,均恢复正常生活和工作,无一例复发。结论腔内激光治疗术结合聚桂醇泡沫硬化剂曲张静脉注射、穿静脉结扎治疗下肢静脉性溃疡效果确切,微创伤,恢复快,达到美腿效果。更多还原     

曲张浅静脉激光闭合术对原发性深静脉功能不全中远期血流动力学和瓣膜功能的影响

目的观察曲张浅静脉激光闭合术对下肢原发性深静脉功能不全中、远期血流动力学和瓣膜功能的影响。方法选择2010年1月-12月接受曲张浅静脉激光闭合术治疗的854例下肢原发性深静脉功能不全病例,应用彩色多普勒超声评估术前和术后1、6和12个月时,股浅静脉第一对瓣膜静脉反流指数的变化。结果 321例术前轻度瓣膜反流患者,在术后1、6和12个月时的瓣膜反流改善率分别为57.6%、72.0%和86.9%。301例中度瓣膜反流患者和232例重度瓣膜反流患者,在术后1、6和12个月时瓣膜反流改善率分别为15.0%、23.6%、26.2%和8.2%、13.4%和19.4%。轻度瓣膜反流患者术后瓣膜反流改善率与中度和重度患者相比,差异均有统计学意义（P均〈0.05）。结论曲张浅静脉激光闭合术能够有效改善股浅静脉第一对瓣膜轻度反流患者的瓣膜反流程度。     

Full-valve annuloplasty in treatment of primary deep venous valvular incompetence of the lower extremities.

Full-valve annuloplasty of superficial femoral venous valves was performed successfully in 139 extremities affected with primary deep venous incompetence of the lower limb. Chronic ulcerations in 43 affected extremities healed after operation. Postoperative venography showed that the recovery rate of valvular function was 97%, and no serious complication was noted. Follow-up for a mean of 3.5 years showed no varicosed vein and no recurrence of ulceration. The principles of operation, the optimum site, number and degree of annuloplasty, indications and results of the operation were discussed.

     

THE FORMATION OF ''''SUBSTITUTE VALVE'''' AT THE POPLITEAL VEIN IN THE TREATMENT OF PRIMARY VALVULAR INCOMPETENCE OF THE DEEP VEINS IN LOWER EXTREMITY

Forty-five patients (47 limbs) with primary valvular incompetence of deep veins in the lower extremity treated by "substitute valve" operation have been followed for a mean period of 35.54 months with satisfactory results. This procedure is the operation of choice in the treatment of this newly recognized venous disease of the leg. A small percentage of post-thrombotic legs in which the deep vein is completely recanalized constitutes also an indication for this operation. Five patients (5 limbs) of this type operated upon have been followed for over one year with good results. The mechanism of the "substitute valve" in relieving symptoms in the diseased limbs lies in the vigorous massage at the popliteal vein to accelerate venous return rather than acting merely as a barrier to prevent the reflux of blood in the deep venous system. The authors advocate that this operation be recommended for the treatment of venous disease of the lower extremity with typical hemodynamic changes of blood reflux in the deep venous system.     

下肢静脉性溃疡的血流动力学变化

目的：探讨下肢静脉性溃疡的血流动力学变化情况。方法：通过多普勒超声检查技术对65例，68条下肢静脉性溃疡患肢的下肢静脉系统进行检测。结果：所有患肢均见到静脉返流或瓣膜功能不全 ，其中浅静脉64条94．12％，深静脉38条50．88％，交通支静脉41条60．29％。68条患肢共出现五种形式血流动力学变化，其中主要为联合形式的血流动力学变化79．41％。结论：静脉性溃疡的手术治疗，关键在于查出静脉性溃疡血流动力学变化详细情况，并给予全面去除。     

Highly selective vagotomy and duodenal ulcers that fail to respond to H2 receptor antagonists

A study was conducted to see whether patients with duodenal ulcers that failed to heal in response to H2 receptor antagonists had a higher incidence of recurrent ulceration after highly selective vagotomy than patients whose ulcers healed with these drugs. Between 1977 and 1983, 157 patients had a highly selective vagotomy for uncomplicated duodenal ulcer; in 57 patients the ulcer had failed to heal despite treatment with H2 receptor antagonists (refractory group), 19 patients had developed recurrent ulceration while receiving maintenance treatment, 67 patients had remained healed while taking H2 receptor antagonists but suffered frequent relapses when treatment was stopped, and 14 patients had not been given these drugs before operation. The overall incidence of recurrent ulceration was 6% after two years and 11% after five years of follow up. In the refractory group, however, the incidence of recurrent ulceration was 18% at two years and 34% after five years, whereas the incidence of recurrence was only 1.5% at two years and 3% after five years in patients whose ulcers had healed with H2 receptor antagonists. Resistance to H2 receptor antagonists was not related to preoperative basal or peak acid output but was related to cigarette smoking. Factors associated with recurrent ulceration after highly selective vagotomy were basal acid outputs before and after operation, cigarette smoking, and the surgeon who performed the operation. Duodenal ulcers that fail to respond to H2 receptor antagonists represent a more severe ulcer diathesis, for which highly selective vagotomy is less effective.     

下肢近端静脉倒流对远端静脉功能影响的研究

为阐明近远端静脉功能与慢性静脉功能不全（ＣＶＩ）的关系以及远端静脉瓣膜重建术改善临床症状有机制，以双功彩超探测了７３条ＣＶＩ患肢的静脉流动力学，分别检测股浅静脉，股深静脉，Ｇｏｎｇ静脉，大隐静脉和小隐静脉的倒流的时间，倒流的峰速和静脉的管径，结果：股浅静脉倒流存在的肢体Ｌｏｎｇ静脉倒流的发生率明显增加（Ｐ〈０．００５），Ｇｏｎｇ静脉的管径也明显增粗（Ｐ＝０．０００３）Ｇｏｎｇ静脉倒流存在的肢体约８     

大隐静脉术后出现下肢肿胀和复发的原因分析

目的:探讨大隐静脉术后出现下肢肿胀和复发的原因。方法:总结我院从2006年9月~2008年2月下肢静脉曲张术后复发病人的临床资料。所有病人患肢均行浅深静脉和交通静脉彩色多普勒超声检查和深静脉顺行造影。结果:合并大隐静脉主干及其部分属支残存11条肢体,合并深静脉瓣膜功能不全16条肢体,合并交通静脉功能不全26条肢体,合并深静脉血栓后遗症6条肢体,合并Cocket综合征2条肢体,合并淋巴瘤2例。结论:下肢静脉曲张术后复发的原因较为复杂,通常累及3个静脉系统。交通静脉和深静脉瓣膜功能不全是术后复发的主要原因。术前行彩色多普勒超声检查和患肢深静脉顺行造影,选择合理的手术方式是避免术后复发的关键。     

分期疗法治疗慢性静脉性溃疡临床研究

目的探讨分期疗法对慢性下肢静脉性溃疡(chronic venous leg ulcer,CVLU)的治疗效果。方法本院2011-09～2012-03共收治22例下肢CVLU,均采用分期疗法,观察治疗效果和溃疡愈合及复发情况。结果 22例中除1例伴髂静脉受压综合征经一期治疗2周无效而放弃,21例溃疡愈合,曲张静脉消失(95.5%,21/22)。于治疗后1月和3月复诊,彩色超声显示:12例深静脉返流患者,7例(58.3%)返流消失,5例(41.7%)返流明显减轻;8例下肢皮肤色素沉着明显减轻(38.1%,8/21)。结论分期疗法是治疗CVLU的可行性手段。     

Anatomical, radiological and histological investigation of the great and small saphenous veins

OBJECTIVE: To provide information on superficial veins of the lower limb such as anatomic variations, valve distribution, termination forms, and histological properties of vein walls. METHODS: Two hundred greater saphenous veins in 200 patients and 10 cadavers were investigated. Ultrasound examinations were performed in the Department of Radiology, Ataturk Hospital between December 2004 and October 2005. RESULTS: The lateral accessory branch of the great saphenous vein was found in 75 persons while in 48 persons no major branch was encountered. In addition, medial accessory branch of the great saphenous vein was observed in 17 (8.5%) on both sides. The popliteal type of termination was found in 211 cases. The small saphenous vein gave off perforating branches to the popliteal vein in 29 persons. The diameters of such veins were all measured on both sides of the cadavers and ultrasonographically on patients. Statistical analyses revealed no significant difference. One hundred and fifty-six valves were classified according to their position and type. The maximum number of valves was found in the first interval and the minimum number was in the second interval. The valves were mostly in Type III format. CONCLUSION: Knowledge on the anatomic variations and characteristics of the valves of the superficial veins of the lower limbs can be helpful in clinical practice and surgical operations concerning the lower extremity.     

静脉腔内激光治疗下肢淤滞性溃疡的疗效观察

目的：探讨静脉腔内激光在治疗下肢淤滞性溃疡方面的临床应用价值。方法：对我院共收治的下肢静脉曲张合并慢性溃疡21例患者,均行静脉腔内激光治疗大隐静脉曲张,同时激光烧灼溃疡面下的曲张静脉及交通静脉,术后弹力绷带加压包扎半个月,改穿弹力袜3～6个月。结果：21例溃疡均于3～6周愈合,经随访,最长23个月,未见溃疡复发。结论：静脉腔内激光（EVLT）是一种较好的治疗下肢淤滞性溃疡的方法,操作简单,创伤小,恢复快,值得推广应用。     

腔镜辅助手术治疗下肢原发性静脉曲张

目的:探讨腔镜技术在下肢原发性静脉曲张手术中应用的可行性和结果。方法:腔镜辅助手术治疗24例(32条患肢)下肢原发性静脉曲张病人。术后随访3～22个月;传统手术治疗20例(27条患肢)下肢原发性静脉曲张病人.术后随访5～24个月。结果:腔镜辅助手术治疗24例病人术后肢体症状和浅静脉曲张消失,16例合并有静脉性溃疡患者短期内溃疡愈合,随访3～22个月只有1(1/32)条患肢复发静脉曲张,其余病人未见静脉曲张复发及并发症;而传统手术治疗20例病人术后肢体症状和浅静脉曲张消失,10例合并有静脉性溃疡患者短期内溃疡愈合,随访5～24个月有3(3/27)条患肢复发静脉曲张,2(2/10)条患肢复发溃疡。结论:腔镜辅助手术治疗下肢原发性静脉曲张手术效果好,术后复发率低,患肢创伤小,病人满意度高,是治疗下肢原发性静脉曲张的有效方法。     

下肢静脉返流性疾病的综合治疗

目的 探讨下肢静脉返流性疾病的综合治疗方法。方法 91例（104条下肢）经静脉造影明确诊断，分别施行：①浅静脉术式组行大隐静脉高位结扎剥脱术与电凝术78条下肢。②交通静脉术式组在浅静脉术式基础上加定位交通静脉结扎切断破坏术26条下肢。③深静脉术式组在浅静脉或交通静脉术式基础上加股浅静脉戴戒术20条肢体。随访2—36月。结果 术后下肢肿胀无改善6条肢体，加重2条，均为股浅静脉戴戒术，其中深静脉血栓形成1例。2例股淋巴漏，溃疡复发1例，其余病例均痊愈。结论 股浅静脉瓣膜戴戒术对原发性下肢深静脉瓣膜功能不全的术后效果有待进一步随访观察结果。大隐静脉高位结扎剥脱、电凝术加定位交通静脉结扎术合理组合运用，效果满意。     

隐-股静脉瓣膜功能的临床检测

目的 :检测隐 -股静脉瓣膜功能在下肢静脉曲张中的变化。方法 :2 5 8例下肢静脉曲张患者 ,共 30 8条患肢 ,通过多普勒超声技术检查 ,深静脉顺行造影 ,对隐 -股静脉瓣膜及深静脉瓣膜功能进行测试。结果 :下肢静脉曲张隐 -股静脉瓣膜功能不全平均阳性率 90 .14 % ,仅有隐 -股静脉瓣膜功能不全平均阳性率 16 .11%。结论 :隐 -股静脉瓣膜功能不全仅是下肢静脉曲张的一种常见病理变化 ,下肢静脉曲张手术时重点要纠正深静脉瓣膜功能不全 ,但不能忽视隐 -股静脉瓣膜功能不全处理。