下肢深静脉血栓形成后遗症误诊为下肢单纯性浅静脉曲张的外科处理

Surgical treatment of postthrombotic syndrome in lower extremities

目的探讨下肢深静脉血栓形成后遗症外科处理。方法回顾1992年1月～2006年12月共收治26例下肢深静脉血栓形成(deep vein thrombosis,DVT)后遗症在外院误诊为单纯性下肢浅静脉曲张而行浅静脉高位结扎剥脱术,其中3例首次剥脱术后浅静脉曲张复发而再次行曲张浅静脉剥脱术。入院后根据不同情况采取不同治疗方法。结果本组病例采用半腱肌-股二头肌腱袢月国静脉瓣膜代替术17例(18条肢体);髂总静脉-股浅静脉转流术6例(人工血管5例,自体血管1例);耻骨上大隐静脉交叉转流术1例;保守治疗2例。平均随访3.2年显示,除5例(19.2%)患者1年后仍稍感患肢沉重外,余21例(80.8%)患者上述症状明显好转,体征基本消失。结论根据下肢深静脉血栓形成后遗症的不同情况采取不同治疗方法。

[Objective] To review the surgical management of patients with postthrombotie syndrome of lower extremities. [Methods] From 1992 to 2006, 26 patients with postthrombotic syndrome of lower extremities were admitted. All patients were treated by the ligation and strip of great saphenous veins in other hospital before admitted to our hospital. The second ligation and strip of great saphenous veins were made in 3 of these patients. All patients were treated by different treatments in our hospital. [Results] 26 patients were treated by substitude politeal vein valve operation in seventeen cases, iliofemoral bypass in six, cross bypass of great saphenous vein in one, and nonoperation in two. The clinical manifestations vanished after the treatments except five patients with heaviness. The follow-up periods were 3.2 years. The function of the lower extremities recovered satisfactorily. [Conclusions] Dif- ferent types of postthrombotie syndrome of lower extremities should be rendered by different therapeutic procedures after the diagnoses were made.