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。

Ultrasound-assisted external valvuloplasty in the treatment of primary deep venous insufficiency of lower extremity

Objective To examine the external valvuloplasty with the aid of color Doppler ultra- sound for primary deep venous insufficiency（PDVI） of lower extremity. Methods Clinical data of 63 pa- tients with PDVI of lower extremity（74 diseased limbs）who underwent external valvuloplasty in our hospi- tal from Oct 2004 to Feb 2009 were retrospectively analyzed. According to clinical, etiologic, anatomic and pathophysiologic（CEAP） classification,there were C2 in 74 limbs, C3 in 17 limbs, C4 in 36 limbs, C5 in 13 limbs and C6 in 8 limbs. Anterograde visualization of deep venous showed reflux at ]] to 1V grade and varicose superficial veins. All the patients were treated with external valvuloplasty assisted by color Doppler ultrasound, and simultaneously with high ligation, endovcnous laser ablation of great saphenous vein, exfoli- ation of perforating veins. Results The symptoms of all the patients were alleviated. Chronic ulcers were cured within 2 to 4 weeks. Pigmentation was gradually improved. Six months after operation, VCSS scores showed symptoms were alleviated significantly. The diameter and lasting time of reflux flow of valves were remarkably improved postoperatively as compared with those before operation（ P 〈 0.01 ）. A total of 48 pa- tients were followed up for 1 to 5 years without recurrence occurring. Conclusion Ultrasound - assisted external valvuloplasty is effective in the treatment of PDVI of lower extremity.