股深静脉功能不全的手术治疗

Surgical treatment of profunda femoral vein insufficiency

目的探讨腘静脉环缩术和股深静脉结扎术治疗股深静脉功能不全的作用与疗效。方法 34例患者经静脉造影和血管彩超检查证实股深静脉功能不全;CEAP 临床分级,C_431例,C_51例,C_62例。股深静脉形态 Raju 分型,Ⅱ型22例,Ⅲ型10例,Ⅳ型2例。32例在股深静脉与腘静脉交通远侧以及在腓肠肌静脉汇入腘静脉的近侧环缩腘静脉。另2例在股深静脉与腘静脉交通处结扎股深静脉主干。结果 31例患者(91.1%)平均随访4.6年,小腿酸胀痛症状消失,足靴区色素沉着明显消退,溃疡愈合无复发。另3例失访。术后检测下肢运动静脉压与术前比较差异有统计学意义(P<0.01),静脉压力恢复时间大于22s。术后头高足低60°静脉造影,记录造影剂到达髌骨上缘水平腘静脉显影的时间以及立位彩超检测腘静脉每分回流量,与术前比较差异有统计学意义(P<0.01)。结论股深静脉功能不全所致反流对下肢血流动力学的影响密切相关。在腘窝部位选择腘静脉环缩术和股深静脉结扎术治疗股深静脉功能不全是可行有效的。

Objective To study the role and curative effect of encircling construction of the popliteal vein and ligation of the profunda femoral vein（PFV） to treat profunda femoral vein insufficiency （PFVI）. Methods Thirty-four patients were diagnosed as having PFVI through phlebography and color ultrasound syatem. （CEAP clinical scale： C4 31, C5 1, C6 2）. The forms of the profunda femoral veins （PFV） were Raju grouping, type Ⅱ ：22, type Ⅲ ：10, type Ⅳ：2. Thirty-two patients＇ popliteal veins were annularly constructed in the distal communication of the PFV and the popliteal vein, and in the abouchement of gastrocnemius vein into the popliteal vein. The other two PFV trunks were ligated at the communication of PFV trunk and the popliteal vein. Results Thirty-one patients （91.1% ）, 4,6-year follow-up in average, threw off their aching pain in the leg. Pigmentation from the ankle to the middle of the leg subsided; the ulcers were healed and did not relapse. The postoperative ambulatory venous pressure detected was distinguishable from the preoperative data （P 〈 0. 01 ）, venous pressure recovery time 〉 22 seconds. A standing position （60 degrees from the vertical） is used in the postoperative phlebography. And the development time of the contrast media reaching the superior margin of patellar level, together with the regurgitation volume per minute of the popliteal vein detected through color ultrasound system in a standing position, was recorded. The patients＇ physical status had been greatly improved after the surgery （P 〈0. O1 ） . Conclusions The back flow caused by PFVI has a deep impact on the hemodynamics of the lower limb. In the popliteal fossa, it is operable and effective to use encircling construction of popliteal vein and the ligation of the PFV to treat PFVI.