下肢深静脉瓣膜功能不全的手术方法分析

The outcome of different operation approaches in the treatment of primary deep venous insufficiency

目的评价不同手术方法治疗原发性下肢深静脉瓣膜功能不全的疗效。方法150例患者（240肢）经顺行静脉造影证实为原发性下肢深静脉瓣膜功能不全,分为3组,每组80肢。A组行股浅静脉瓣膜外戴戒术,B组行股浅静脉瓣膜外修补术,C组行腘静脉半腱肌-股二头肌肌襻代瓣膜术。3组均同时行大隐静脉高位结扎剥脱术加交通支结扎术。以CEAP临床分级与临床记分评价疗效。结果 C2~C4患肢手术前后临床记分差值任意两组间比较,差异均有统计学意义（P〈0.01）;与A组比较,B、C组C5患肢手术前后临床记分差值的差异有统计学意义（P〈0.01）;与A、B组C6患肢手术前后临床记分差值比较,C组差异有统计学意义（P〈0.01）;A组和B组比较,差异无统计学意义（P〉0.05）。3组术后临床记分均低于术前[A组（4.41±1.19）分vs.（3.40±2.18）分,B组（4.35±1.26）分vs.（2.35±2.41）分,C组（4.44±1.22）分vs.（2.38±2.24）分;P均〈0.01]。结论原发性股浅静脉瓣膜功能不全的手术治疗应依据深静脉瓣膜功能不全的程度决定手术方式。

Objective To investigate the therapeutic effect of different operation approaches in the treatment of primary deep venous insufficiency（PDVI）.Methods Two hundred and forty lower limbs in 150 PDVI patients who were divided into 3 groups（80 limbs in each group）.The encircling constriction of venous wall at the first valve of the superficial femoral veins was carried out in group A,surgical repair of the incompetent valve of superficial femoral veins was carried out in group B,semitendinosus-biceps femoris substitute valve operation outside the popliteal vein was carried out in group C.And all the patients were also treated with the high ligation and ablation of great saphenous vein,ablation of superficial veins and ligation of perforatoring veins at the same time.Ascending CEAP classification and clinical scoring were performed from 2 months to 6 years after operation to evaluate the efficacy.Results Compared with any 2 groups,the differences of pre-operative and post-operative scores at C2-C4 were significant（P 0.01）.Compared with group A,there were statistical significance of the difference scores at C5 in group B,C（P 0.01）.Compared with group A,B,there were statistical significance of the difference scores at C6 in group C（P 0.01）.Conclusion The selection for operation approach in the treatment of PDVI should be based on the degree of PDVI.