大隐静脉曲张高位结扎剥脱术的疗效观察

Treatment of great saphenous varicose by high ligation plus stripping of great saphenous vein

目的:观察大隐静脉曲张伴原发性下肢深静脉瓣膜功能不全行单纯大隐静脉高位结扎剥脱术的疗效,探讨下肢浅静脉曲张伴原发性下肢深静脉瓣膜功能不全的合理治疗方式及二者的关系。方法:分析1996年4月至2003年9月间收治的单纯大隐静脉曲张(简称隐曲组)患者321例及大隐静脉曲张伴原发性下肢深静脉瓣膜功能不全(简称隐深组)患者 45例手术前后症状、体征、血流动力学的变化及复发率。结果:两组手术均成功;总随访率89．4％,平均随访6．04年。隐曲组复发率1．16％,隐深组无复发者,两组复发率无显著差异(P>0．05)。隐曲组的绝大部分症状、体征(除水肿外)均于术后得到明显改善,隐深组除疼痛、搔痒、湿疹外其余症状、体征均于术后得到明显改善(P<0．05),隐深组虽然术后仍存在着病理性返流,但较术前亦有明显的减轻(P<0．01),在返流程度方面手术前后亦无明显变化(P>0．05)。结论:对大隐静脉曲张伴原发性下肢深静脉瓣膜功能不全者,单纯行大隐静脉高位结扎剥脱术的疗效满意。

Objective： To observe the effects of high ligatien and venous stripping of great saphenous vein alone on treatment of great sapbenous varicose with primary deep venous valve insufficiency and to evaluate the reasonable curative methods for this disease. Methods： Before and after surgical operation, the changes of symptoms, signs, blood flow dynamics and recurrence rate were compared between group A of 321 patients（343 legs） with great saphenous varicose and group B of 45 patients（54 legs） with great saphenous varicose complicated by primary deep venous valve insufficiency from Apr.1996 to Sep.2003 in our department. Results： The surgical operation was successful in both group and 89.4% of the patients were followed - up with an average followed up time of 6.04 years. The recurrence rate was 1.6% in group A and 0 in group B and there was not any significant difference of the recurrence rate between both groups（p 〉 0.05）. A lot of symptoms and signs in group A（except edema） and group B（except pain, itch and eczema） had a great improvement（p 〈 0.05）. The pathological reflux through deep vein valve decreased significantly in group B（p 〈 0.01）. Conclusion： Treatment of great saphenous varicose with primary deep venous valve insufficiency by high ligatiou and venous stripping of great saphenous vein gets a satisfactory curative offect.