下肢静脉曲张的血流动力学分型与治疗

Hemodynamic model and treatment of varicose veins in lower extremities

目的分析下肢静脉曲张的血流动力学变化并予以分型,探讨血流动力学纠正术治疗下肢静脉曲张的疗效。方法选取第二军医大学第三附属医院、上海交通大学医学院附属新华医院崇明分院和浙江省苍南县人民医院等三家医院286例原发性下肢静脉曲张患者(350条患肢),行Trendelenburg试验、Perthes试验、Pratt试验和彩色超声检查,分析下肢静脉曲张的血流动力学变化并予以分型。根据血流动力学分型予每个患者行个体化的血流动力学纠正术,随访2年观察术后的并发症和疗效。结果根据下肢浅静脉的反流和回流情况,将下肢静脉曲张的血流动力学变化分为6个类型。患者均根据血流动力学分型予以行血流动力学紊乱的纠正术。在2年随访中,8例(2.8%)患者术后出现隐神经损伤,26例(9%)患者并发血栓性浅静脉炎,复发9例(4%)。结论我们提出了更合理、科学的下肢静脉曲张血流动力学分型,在此分型基础上施行的血流动力学纠正术,是安全有效的,有更少的并发症和更低的复发率。

Objective To investigate the hemodynamic changes and types of varicose veins in lower extremities, and to evaluate the efficacy of hemodynamic corrective surgery for varicose veins of lower extremities. Methods We systematically analyzed 350 limbs of 286 patients with primary varicose veins in lower extremities at the Third Affiliated Hospital of Second Military Medical University, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Cangnan People ＇s Hospital from February 2013 to February 2015. Venous hemodynamic changes and types were evaluated by performing Trendelenburg test, Perthes test, Pratt test, and color ultrasound examination. According to the hemodynamic type to treatment individually for patients with varicose veins. Patients were studied for 2 years following surgery. Results According to the reflux and re-entry of superficial vein, the hemodynamic changes of lower extremity varicose veins were divided into 6 types. Hemodynamic correction had been per-formed in 286 cases based on the individual hemodynamic type. At the 2-years follow-up, saphenous nerve injury in 8 cases（2.8%）, 26 patients（9%） with superficial thrombophlebitis, recurrence in 9 cases（4%）.Conclusion The hemodynamics type of varicose veins in lower extremity in our study is more reasonable and applicable. The hemodynamics corrective surgery for varicose veins based on our type is safe and effec-tive, with less complication and lower recurrence rate.