【摘要】 目的探讨中老年患者继发性大隐静脉曲张的临床治疗方案及疗效。方法选取2010-10—2012-10间诊治的继发性大隐静脉曲张中老年患者80例,根据临床症状及深静脉侧枝循环建立情况分为2组。早期(以静脉回流障碍为主,深静脉侧枝循环未能建立)40例患者行保守治疗为A组,后期(以大隐静脉血液倒流为主,深静脉侧枝循环已建立)40例患者行手术治疗为B组。分析2组患者的相关指标改变情况和治疗效果。随访6个月,观察复发情况。结果 (1)治疗后,2组患者下肢静脉血流速度均显著增加,而足背静脉压均显著降低,与治疗前相比较,差异均有统计学意义(P<0.05)。B组下肢静脉血流速度高于A组,足背静脉压低于A组,但差异均无统计学意义(P>0.05)。(2)A组总有效率为97.5%,B组总有效率为100.0%,差异无统计学意义(P>0.05)。(3)随访6个月,B组复发率低于A组。差异均无统计学意义(P>0.05)。结论继发性大隐静脉曲张患者早期以静脉回流障碍为主,大隐静脉代偿性曲张,起保护作用,为手术禁忌,宜保守治疗。后期侧支循环建立,深静脉闭塞、再通或部分再通,但瓣功能丧失,导致肢体静脉高压,大隐静脉曲张进行性加重主要是以静脉血液倒流引起。手术能减少血液倒流、降低或解除肢体静脉高压,缓解患者临床症状。更多还原

【Abstract】 Objective To investigate clinical treatment procedure and clinical effect in elderly patients with secondary saphenous varicose veins. Methods Eighty elderly patients with secondary saphenous varicose veins were selected in our hospital from October 2010 to October 2012. According to clinical symptoms and deep venous collateral circulation,the included 80 patients were divided into two groups( Group A: early stage group and Grouip B: advanced stage group) with each group 40 cases. Patients in group A received conservative treatment( venous reflux disorder while deep vein failed to establishment of collateral circulation). And patients in group B received operation treatment in late stage( great saphenous vein blood backflow while deep vein establishment of collateral circulation). Patients in the two groups were followed up for 1 year. Changes of related indexes; treatment effect; symptoms improvement situation; recurrence were analyzed. Results After treatment,flow velocity of great saphenous vein increased significantly while dorsal venous pressure decreased significantly in the two groups. Skin pigmentation disorder disappearance rate; lower limb ulcer healing rate; lower limb skin rash symptoms disappearance rate in B group were significantly higher than that of A group( P < 0. 05). After 1 year follow- up,recurrence rate in B group was significantly lower than that of A group( P < 0. 05). Differences were statistically significant( P < 0. 05). Flow velocity of great saphenous vein in B group was faster than that of A group( P < 0. 05). Dorsal venous pressure in B group was lower than that of A group( P < 0. 05). Total effective rate in B group was higher than that of A group( P < 0. 05). After 6 months follow- up,recurrence rate in B group was lower than that of A group but without statistically significant( P > 0. 05). Conclusion Patients with secondary saphenous varicose veins have venous reflux disorder and compensatory varicose of great saphenous vein in early stage,which has role of protection and can chose conservative treatment. Patients in advanced stage have establishment of collateral circulation and deep veinrecanalization or partial recanalization,but flap function loss,which can cause limb venous hypertension. Varicosis of great saphenous vein progressive is caused by venous blood backflow. Operation can reduce blood flow and reduce or cancel limb venous hypertension,which can relieve clinical symptoms.更多还原