原发性下肢深静脉瓣膜功能不全手术方法选择.docVIP

原发性下肢深静脉瓣膜功能不全手术方法选择 　 作者:陈辉，张方，王天佑，陈学明，许晓航，陈福森 【摘要】 目的 观察不同手术方法治疗原发性下肢深静脉瓣膜功能不全的疗效。方法 150例(240条肢体)经顺行静脉造影证实为原发性下肢深静脉瓣膜功能不全的患者分为A、B、C 3组，每组80条患肢。A组行股浅静脉瓣膜外戴戒术，B组行股浅静脉瓣膜外修补术，C组行腘静脉半腱肌-股二头肌肌襻代瓣膜术，3组均同时行大隐静脉高位结扎剥脱术加交通支结扎术。以CEAP临床分级与临床记分评价疗效。结果 3组术后临床记分呈不同程度下降：Ａ组中C2～C4者手术效果较好；B组中C2～C5者手术效果较好；C组中C2～C6者手术效果较好；A、B、C 3组手术效果比较，对C2～C4者，3组无明显差异；对C5者，B、C组无明显差异，但A组效果较差；对C6者，C组效果较好，但A、B组效果较差。结论 原发性股浅静脉瓣膜功能不全的手术治疗，应依据深静脉瓣膜功能不全的程度决定手术方式。 【关键词】 原发性股浅静脉瓣膜功能不全；瓣膜外戴戒术；瓣膜外修补术；腘静脉半腱肌-股二头肌肌襻代瓣膜术 The selection for operation method in treatment of primary deep venous insufficiency 【Abstract】 Objective To observe the therapeutic effect of different operation methods in the treatment of primary deep venous insufficiency (PDVI).Methods Two hundred and forty lower limbs in one hundred and fifty patients who were proved to be PDVI by ascending venography were divided into Group A(80 limbs)，Group B(80 limbs) and Group C(80 limbs).Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins.Patients of Group B were treated with the surgical repair outside the incompetent valve of superficial femoral veins.Patients of Group C were treated with the semitendinosus-biceps femoris substitute valve operation outside the popliteal vein.And they were also treated with the high ligation and ablation of great saphenous vein，ablation of superficial veins and ligation of perforator veins at the same time.Ascending CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation.Results The difference between preoperative and postoperative scores of Group A，Group B and Group C were remarkable(Group A，P＜0.01；Group B，P＜0.01；Group C，P＜0.01).To C2～C4，there were no apparent difference among three groups.To C5，the therapeutic effect of Group A was bad.To C6，the therapeutic effect of Group C was fairly good.Conclusion The selection for operation method in the treatment