下肢深静脉血栓形成后综合征外科治疗.docVIP

下肢深静脉血栓形成后综合征外科治疗 　 作者：殷敏毅　黄新天　蒋米尔　刘晓兵　李维敏　黄英　陆信武　陆民　张培华 【摘要】 目的：探讨下肢深静脉血栓形成后综合征的外科治疗效果。方法：回顾分析1996年12月—2005年12月收治的下肢深静脉血栓形成后综合征患者的临床资料。全组105例患者，共114条患肢，其中23条行大隐静脉交叉转流术，5条行原位大隐静脉-腘静脉转流术，4条行髂静脉介入治疗，2条行腘静脉外肌袢形成术，38条行曲张浅静脉剥脱术，部分联合交通静脉结扎和（或）溃疡清创植皮术，22条行曲张浅静脉腔内激光术，部分联合溃疡清创植皮术，17条行单纯溃疡清创植皮术，3条行溃疡清创联合游离皮瓣移植术。结果：患肢症状明显缓解率57.0 %，部分缓解率40.4 %。6条患肢溃疡未一期愈合，无严重并发症。随访1～9年，7条患肢溃疡复发，4条患肢转流桥闭塞。结论：依据准确的血流状态评价、采用个体化的治疗方案能够有效缓解下肢深静脉血栓形成后综合征的临床症状。 【关键词】 深静脉血栓形成后综合征·外科治疗 Surgical treatment of lower extremity post-thrombotic syndrome 【ABSTRACT】 Objective: To study the effective surgical methods for the post-thrombotic syndrome. Methods: From December 1996 to December 2005, the clinical data of 105 patients（114 limbs） with PTS treated by surgery were analyzed retrospectively. The procedure performed included 23 crossover saphenous vein bypasses, 5 in situ saphenopopliteal bypasses, 4 interventional therapies of iliac venous occlusion, 2 muscular flap constructions on the popliteal vein, 38 varicose vein strippings partly with the ligature of communicating venous and（or） ulceration skingraftings, 22 endovenous laser treatments of varicosis partly with ulceration skingraftings, 17 simple ulceration skingraftings and 3 free flaps transfer for ulceration. Results: Six ulcerations were not primary healing. There was no serious complications. Mean follow-up was （3.2±1.2） years （range, 1 to 9 years）. There were 7 recurrent ulcerations, 4 graft obstructions developed in Palma-Dale operation. Significant remission rate of symptom was 57.0 % and partial remission rate was 40.4 %. Conclusion: Accurate evaluation of blood flow status and personal therapeutic regimen might relieve the symptom of PTS effectively. 【KEY WORDS】 Post-thrombotic syndrome·Surgical treatment 　　深静脉血栓形成后综合征（post－thrombotic syndrome，PTS）是由急性深静脉血栓形成引起，缓慢发展形成的慢性静脉功能不全性疾病，好发于下肢。张培华等［１］统计11 595条慢性静脉功能不全患肢深静脉顺行造影结果，PTS共3 269条，占28.19 %。PTS血流动力学变化复杂，临床症状轻重不一，治疗方法缺乏统一标准，是长期困扰患者和医生的难题。我院血管外科1996年12月—2005年12月收治105例下肢PTS患者，对114条患肢行外科手术