下肢深静脉瓣膜包窄术缩窄比例的个体化初探

Individualization of constriction proportion of superficial femoral vein using external valvuloplasty

目的 评价缩窄比例个体化行人造血管股浅静脉第一瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全的疗效。方法 对 5 4例 ( 5 6条肢体 )施以人造血管股浅静脉第一瓣膜包窄术 ,并根据瓣膜反流程度施以不同的缩窄比例 ,术后观察临床疗效和瓣膜反流情况。结果 术中检查显示 5 4条肢体瓣膜在包窄术完成后不再反流。 5 5条肢体获随访 14～ 3 5个月 (平均 2 3个月 ) ,临床有效率为94.5 %。双功彩超复查瓣膜功能修复率 85 .5 % ,轻、中度反流两组术后瓣膜功能修复率无显著性差异( P >0 .0 5 ) ;重度反流组术后瓣膜功能修复率 66.7%明显低于轻中度反流组的 92 .5 % ( P <0 .0 5 )。结论 行人造血管股浅静脉第一瓣膜包窄术治疗原发性下肢深静脉瓣膜功能不全时 ,应根据术中情况选择不同的缩窄比例。尤其对于轻中度返流的病例 。

Objective To evaluate the therapeutic effect of individualization of constriction proportion using external valvuloplasty of the first pair of superficial femoral vein with expanded polytetrafluoroethylene (ePTFE) implants for primary deep venous insufficiency (PDVI) in lower extremities. Methods External valvuloplasty of the first pair of superficial femoral vein was performed on 54 cases (56 limbs). Individualized proportion of constriction was adopted according to the degree of the venous blood reflux via the valve. Results Intraoperative examination showed that the valve competence rate achieved in 96.4% of 56 limbs after the valvuloplasty was finished. Fifity-five limbs were followed up with a mean period for 23 months( 14 months 35 months). Clinical symptomatic improvement acchived in 94.5% of the limbs. The valve competence recover rate was 85.5% comfirmed by color ultrasounoraphy.There are no statistically differences of the valve competence recover rates between the mild and the moderate PDVI groups (P>0.05). The valve competence recovery rate in severe PDVI group was significantly lower than that of the mild and moderate PDVI groups (both P<0.05). Conclusions The results suggest that the individualized proportion of constriction should be adopted in external valvuloplasty of the first pair of superficial femoral vein, especially for the the limbs with the mild or moderate PDVI. The individualization of constriction proportion is feasible and effective for PDVI of lower extremity.