中国实用外科杂志

中国实用外科杂志

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深静脉瓣膜重建治疗髂静脉狭窄合并重度深静脉反流73例疗效分析

马    杰1，马    韬2   

  1. 1中国人民解放军第210医院血管外科，辽宁大连116012；2复旦大学附属中山医院血管外科，上海200032
  • 出版日期:2015-12-01 发布日期:2015-12-01

  • Online:2015-12-01 Published:2015-12-01

摘要：

目的    探讨行仅纠正静脉反流而不处理髂静脉狭窄的手术治疗深静脉功能不全（DVI）合并左髂静脉狭窄（LIVS）的可行性和疗效。 方法    2007年1月至2014年6月，中国人民解放军第210医院经下肢静脉造影及彩超检查诊断为左髂静脉狭窄并伴有重度深静脉反流73例。其中男14例，女59例；年龄37～62岁，平均49.7岁。全部C4~C6的DVI病人实施腘静脉瓣膜重建并处理大小隐静脉和交通静脉；手术前后观察深静脉血流动力学的改变、左髂静脉血栓的发生以及静脉疾病临床严重度评分（VCSS）来评价效果。 结果    顺行静脉造影发现73例LIVS，其中60例（82.1％）髂静脉狭窄率为50.6％～58.7％，13例（17.9％）狭窄率为60.1％～65.6％。所有病人深静脉造影均为Ⅲ～Ⅳ级反流。手术前血管彩超检测腘静脉平均每分反流量为（812.63±57.42） mL，术后（165.61±10.25） mL（t = 12.17，P＜0.01）。VCSS评分术前（7.98±1.35），术后（1.47±0.68） （t =54.62，P＜0.01）。病人术后平均随访58个月，未发现髂静脉狭窄处血栓形成，肢体疼痛及肿胀消失，溃疡愈合率96.2％，复发率为3.8％。 结论    对非血栓性LIVS合并DVI采用深静脉瓣膜重建及浅静脉和交通静脉手术，不需处理LIVS（＞50％～65％）的方法可行有效。

关键词: 慢性静脉功能不全, 髂静脉狭窄, 腘静脉, 深静脉瓣膜重建手术

Abstract:

Reconstructive surgery for deep vein reflux for left iliac vein stenosis complicated with severe deep venous insufficiency: An analysis of 73 cases        MA Jie*，MA Tao. *Department of Vascular Surgery, No. 210 Hospital of Chinese People's Liberation Army, Dalian116012, China
Corresponding author：MA Jie，E-mail：majie541019@sina.com
Abstract    Objective    To report the clinical outcomes and mid-term results of deep vein valve reconstruction combined with superficial vein surgery in treating deep venous insufficiency (DVI) complicated with left iliac vein stenosis (LIVS). Methods    From January 2007 to June 2014，73 cases of DVI complicated with LIVS (male 14，female 59，mean age 49.7) were diagnosed via ascending venography. Deep venous valve reconstruction surgery were performed. Pre-and postoperative Doppler ultrasound，dynamic venography were conducted. Hemodynamic，thrombosisstatus and venous clinical severity score (VCSS) were recorded and compared. Results    Among 73 cases, venography results showed 60 cases (82.1%) had stenosis rate between 50.6％to 58.7％and 13 cases (17.9%) had stenosis rate between 60.1％ to 65.6％. All the cases had Kistner Class III-IV venous reflux. Postoperative popliteal vein reflux quantity [（165.61±10.25）mL ] was significant lower than preoperative popliteal vein reflux quantity [（812.63±57.42）mL] (t=12.17，P<0.001). VCSS reduced from preoperative （7.98±1.35） to postoperative （1.47±0.68） (t=54.62，P<0.001). All the cases were followed-up for 58 months. No postoperative thrombosis was observed. Limb pain and swelling were relieved；ulcers were healed in 96.2% of the cases；ulcer recurrent rate was 3.8%. Conclusion    The deep vein valve reconstruction surgery at the popliteal vein，combined with great saphenous vein，small saphenous vein and perforator vein surgery in treating DVI complicated with LIVS (>50%～65%) is safe and effective，providing satisfactory long-term results.

Key words: chronic venous insufficiency, iliac vein stenosis, popliteal vein, deep venous valve reconstruction surgery