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腘静脉解剖与其瓣膜建造关系的研究

The application of popliteal vein anatomy study and valve construction procedure

摘要:

目的 利用腘静脉解剖及造影确定腘静脉建造瓣膜的部位,评价在此部位建造瓣膜手术的疗效.方法 1998年2月至2010年11月选择102例严重慢性静脉功能不全患者,在利用39条肢体的解剖资料和862例患者深静脉造影资料对腘静脉解剖进行分析的基础上,行腘静脉瓣膜建造术.其中男性69例,女性33例;年龄48 ~71岁,平均59岁.手术前后应用多普勒超声、连续动态静脉造影和术中静脉压测定,分析手术对深静脉血流动力学的影响,进行静脉疾病临床严重度评分(VCSS)评价远期效果.结果 腘静脉解剖、腘静脉造影显示,93.7%患者的腘静脉段仅有一对瓣膜,均位于腘静脉远侧段的1/3处,瓣膜上方有腓肠肌静脉注入腘静脉.手术前后血管多普勒超声检测腘静脉平均反流量分别为732.3和150.2 ml/min(Z=-8.979,P<0.001).术中静息环缩近端和远端静脉压为(12±3)和(15±3)cm H2O(1 cm H2O =0.098 kPa,t=8.049,P <0.001);术中屏气近端和远端静脉压为(34±15)和(41±14)cmH2O(=8.104,P <0.001).VCSS评分术前9.3±1.9,术后1.8±1.0(t =59.780,P<0.001).本组患者术后平均随访8.9年,溃疡愈合率96.3%,复发率为3.7%.结论 根据腘静脉解剖及造影确定腓肠肌静脉汇入腘静脉的近端为腘静脉建造瓣膜的部位,建造的瓣膜能有效地阻止反流,改善腓肠肌泵的功能,可获得良好的远期疗效.

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abstracts:

Objective To analyze anatomy data of popliteal veins (PV),with the purpose of selection of popliteal venous valves construction segment via venography,and to evaluate the surgical results.Methods From February 1998 to November 2010,after analyzing the popliteal vessel anatomy data of 39 limbs and related phlebography research of 862 cases,102 patients (69 male and 33 female patients,aged from 48 to 71 years,mean 59 years) with severe deep venous insufficiency were selected for popliteal venous valve construction procedures.Doppler ultrasound,continuous dynamic venography,and intraoperative venous pressure measurements were used to assess the hemodynamic changes pre-and postoperatively.Venous clinical severity score (VCSS) were used to evaluate long-term results of deep venous valve construction procedures.Results In the 102 patients,93.7% patients had one pair of valves in popliteal vein (PV),locating in the distal 1/3 segment of PV,with gastrocnemius veins (GV) joining with PV above PV valves.Postoperative blood flow volume of the PV was significantly higher than the preoperative volume (732.3 ml/min vs.150.2 ml/min,t =8.979,P <0.001).The proximal pressure was significantly lower than the distal pressure ((12 ± 3) cm H2O vs.(15 ± 3) cm H2O,1 cm H2O =0.098kPa,t =8.049,P < 0.001).VCSS score was significantly lower after the surgery ((34 ± 15) cm H2O vs.(41±14) cm H2O,t =59.780,P <0.001).Pre-and postoperative hemodynamic changes and VCSS scores were statistically significant (9.3 ± 1.9 vs.1.8 ± 1.0,t =59.780,P < 0.001).Mean follow-up were 8.9 years with an ulcer recovery rate of 96.3%,and a 3.7% ulcer recurrent rate.Conclusions Popliteal vessel anatomy study and venography research provide critical information for the PV valve construction part selection,which stayed proximal to the communications of GV and PV.Restoration of gastrocnemius pump function and satisfactory long-term efficacy are received after valve construction.

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作者: 马杰 [1] 马韬 [2] 赵旭 [1] 李悦萌 [1] 王刃 [1] 吕昕 [1]
第一作者: 马杰
期刊: 《中华外科杂志》2013年51卷5期 403-406页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2013.05.007
发布时间: 2013-08-06
基金项目:
辽宁省科技厅科学技术计划资助项目
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