浅静脉曲张术后下肢深静脉血流动力学变化的研究

Hemodynamics evaluation of the deep vein of lower extremities after surgical treatment of varicose vein

目的探讨浅静脉曲张手术治疗对下肢原发性深静脉功能不全合并下肢浅静脉曲张患者的治疗效果。方法2007年8月至2009年8月期间对128例下肢原发性深静脉功能不全合并静脉曲张患者行大隐静脉高位结扎＋曲张浅静脉腔内电凝术。应用频谱多普勒超声测量平静呼吸状态下和ValsalVa动作时股浅静脉第一对瓣膜下静脉血流动力学指标（包括反流时间、管径、反流速度等），以静脉反流指数（Reflux index，RI）作为评价指标。结果手术治疗浅静脉曲张使60例存在轻度深静脉反流的下肢原发性深静脉功能不全病例中的54例得到了改善，45例中度深静脉反流病例29例得到改善，23例重度深静脉反流病例中仅有7例得到改善，有效率分别是90％，64％，30％。轻度术后反流指数明显改善（t=21．484，P=0．000），中度较术前改善（t=2．173，P=0．035），重度与术前比较，差异无统计学意义（t=1．888，P=0．078）。不同反流程度患者手术前、后的反流指数变化差异有统计学意义（x^2=8．266，P=0．004）。结论微创手术治疗浅静脉曲张可改善临床症状较轻的下肢原发性深静脉功能不全病例的反流程度。

Objective To discuss the effect of surgical treatment of varicose vein on primary chronic venous insufficiency（PCVI） in the lower extremities. Methods Between August 2007 and August 2008, 128 PCVI patients underwent high ligation of the great saphenous vein and endovenous electrocoagulation of the varix superficial vein. Spectrum Doppler ultrasound was used to measure the superficial femoral vein blood flow hemodynamic information beneath the first pair of valve including quiet breathing condition and the Valsalva action （reflux time,caliber,reflux velocity）. Reflux index （RI） was used as guide line. Results Clinical sympotoms improved in 54 out of 60 mild PCVI cases, in 29 of 45 moderate PCVI patients, while only in 6 out 23 cases in whom severe preoperative clinical symptom with PCVI was present. The effective rate respectively was 90%, 64%, and 30%. The mild reflux index significantly improved than that before operation （ t = 21. 484, P = 0. 000 ）, the moderate reflux index improved than that before operation （t = 2. 173, P = 0. 035 ） , while the serious reflux index were not statistically improved than that before operation（ t = 1. 888, P = 0. 078 ）. In all cases reflux index improved after the surgery （ X2 = 8. 266,P = 0. 004）. Conclusions Minimally invasive surgical treatment of varicose veins can improve the reflux of the deep vein in PCVI cases with mild to moderate clinical symptom.