腘静脉环缩术治疗严重下肢深静脉倒流性疾病

Annular constriction of popliteal vein for treating severe venous insufficiency

目的 研究和评价应用静脉环缩术治疗严重下肢深静脉倒流性疾病的机理和疗效。 方法 对 78例下肢深静脉瓣膜功能不全 (Ⅲ ,Ⅳ级 )、2例深静脉血栓形成后再通及 2例深静脉无瓣症患者 ,用人造血管环缩静脉管径 1/ 3。并在手术前、后及术中 ,在环缩处近、远侧分别于静息和屏气状态下检测静脉压。 结果 手术前静脉压为 ( 94 7± 8 4 )mmHg ,手术后为 ( 87 9± 7 9)mmHg差异有显著性意义 (P <0 0 1)。术中测压发现静脉环缩处近、远侧存在压力差 ,静息状态下近侧压为( 9 4± 4 5 )mmHg( 1mmHg=0 13 3kPa)、远侧压为 ( 16 5± 8 2 )mmHg ;屏气状态下近侧压为 ( 3 2 4±16 2 )mmHg、远侧压为 ( 4 1 2± 2 8 1)mmHg ,两侧压力差异均有极显著意义 (P <0 0 1)。术后患者症状完全消失或明显减轻 ,溃疡愈合。静脉压下降 60 %以上 ,压力恢复时间大于 2 2s。彩超复查和深静脉造影观察环缩以下无倒流 ,显现瓣膜样作用。 结论 静脉环缩术是治疗严重下肢深静脉倒流性疾病的有效方法。

Objective To study the mechanism and therapeutic effects of annular constriction for severe venous insufficiency of legs. Methods Annular constriction of popliteal vein was performed by Gore Tex vascular graft in 82 patients.Among them,78 patients had deep venous valve insufficiency of legs(Ⅲ,Ⅳ degree), 2 postphlebitic syndrome, and 2 valve absence of deep vein. Under normal respiration and breath holding, venous pressue was measured at the proximal and distal part from the constricting site. Results Great difference was noted in the venous pressure between the proximal and distal part from the constricting site. The pressure was (9 4±4 5)mm Hg,(41 2±28 1)mm Hg at calm and(32 4±16 2)mm Hg,(41 2±28 1)mm Hg at breath holding( P <0 01). Symptoms disappeared or released after operation. Ulcer healed in all patients. Venous pressure decreased by over 60%. Pressure recovery time was over 22 seconds. There was no reflux distal to the constricting site. Deep venous angiography and color Doppler showed an effect similar to venous valve. Conclusion Annular constriction is effective in treating severe venous insufficiency of legs.