Recognition on Surgical Treatment of Chronic Venous Insufficiency in Lower Limb at Present_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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時德 , 趙渝

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下肢; 慢性; 靜脈功能不全; 治療; 大隱靜脈高位結扎術; 剝脫術; 深靜脈瓣膜重建術

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周圍靜脈疾病是臨床上的常見病和多發病，其發病率為20%～40%，皮膚營養障礙占2%～5%［1，２］ ,發病率比動脈疾病約高10倍，發病機理比動脈疾病復雜，分類方法亦不一致，至今存在著爭論。下肢慢性靜脈功能不全（chronic venous insufficiency,CVI）按其病因可分為原發性、繼發性及先天性; 按解剖范圍可分為淺、深和交通靜脈3個系統，亦即包括淺靜脈曲張、深靜脈瓣膜功能不全、深靜脈血栓形成后遺癥、交通靜脈瓣膜功能不全等［３，４］。多年來下肢淺靜脈曲張主張施行大隱靜脈高位結扎加剝脫術，但術后復發者較多。近年來，隨著國內、外學者對CVI的深入研究，尤其是對深靜脈瓣膜功能不全的認識，使傳統下肢淺靜脈曲張的概念發生了根本轉變。下肢淺靜脈曲張已不再被認為是一個獨立的疾病，而是一種可由多種不同病因引起的共同臨床表現……

Citation： 時德,趙渝. Recognition on Surgical Treatment of Chronic Venous Insufficiency in Lower Limb at Present. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(6): 421-424. doi: Copy

1.	Taheri SA, Lazar L, Elias S, et al. Surgical treatment of postphlebitic syndrome with vein valve transplant [J]. Am J Surg, 1982; 144(2): 221-224.
2.	Schanzer H, Peirce EC 2nd. A rational approach to surgery of the chronic venous statis syndrome 　[J]. Ann Surg, 1982; 195(1): 25-29.
3.	Meissner MH, Eklof B, Smith PC, et al. Secondary chronic venous disorders [J]. J Vasc Surg, 2007; 46 Suppl S: 68S-83S.
4.	Meissner MH, Gloviczki P, Bergan J, et al. Primary chronic venous disorders [J]. J Vasc Surg, 2007; 46 Suppl S: 54S-67S.
5.	Belcaro G, Labropoulos N, Christopoulos D, et al. Noninvasive tests in venous insufficiency [J]. J Cardiovasc Surg (Torino), 1993; 34(1): 3-11.
6.	Schultheiss R, Billeter M, Bollinger A, et al. Comparison between clinical examination, cw-Doppler ultrasound and colour-duplex sonography in the diagnosis of incompetent perforating veins [J]. Eur J Vasc Endovasc Surg, 1997; 13(2): 122-126.
7.	van Rij AM, Jiang P, Solomon C, et al. Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography [J]. J Vasc Surg, 2003; 38(5): 935-943.
8.	Pichot O, Kabnick LS, Creton D, et al. Duplex ultrasound scan findings two years after great saphenous vein radiofrequency endovenous obliteration [J]. J Vasc Surg, 2004; 39(1): 189-195.
9.	Puggioni A, Lurie F, Kistner RL, et al. How often is deep venous reflux eliminated after saphenous vein ablation? [J]. J Vasc Surg, 2003; 38(3): 517-521.
10.	Padberg FT Jr, Pappas PJ, Araki CT, et al. Hemodynamic and clinical improvement after superficial vein ablation in primary combined venous insufficiency with ulceration [J]. J Vasc Surg, 1996; 24(5): 711-718.
11.	Ting AC, Cheng SW, Wu LL, et al. Changes in venous hemodynamics after superficial vein surgery for mixed superficial and deep venous insufficiency [J]. World J Surg, 2001; 25(2): 122-125.
12.	Makarova NP, Lurie F, Hmelniker SM. Does surgical correction of the superficial femoral vein valve change the course of varicose disease? [J]. J Vasc Surg, 2001; 33(2): 361-368.
13.	Tripathi R, Sieunarine K, Abbas M, et al. Deep venous va-lve reconstruction for non-healing leg ulcers: techniques and results [J]. ANZ J Surg, 2004; 74(1-2): 34-39.
14.	王深明. 下肢慢性靜脈功能不全外科治療的現狀與爭議 [J]. 外科理論與實踐， 2005； 10(1): 4-7.
15.	陸民. 外科手術在治療慢性靜脈功能不全中的作用 [J]. 臨床外科雜志, 2008; 16(5): 299-301.
16.	Toporcer T, Lakyová L, Radonak J. Venous ulcer－present view on aetiology, diagnostics and therapy [J]. Cas Lek Cesk, 2008; 147(4): 199-205.
17.	王深明，胡作軍，李曉曦，等. 內鏡筋膜下交通靜脈結扎術治療重度慢性下肢靜脈功能不全51例 [J]. 中華普通外科雜志, 2003； 18(9): 527-529.
18.	Bianchi C, Ballard JL, Abou-Zamzam AM, et al. Subfascial endoscopic perforator vein surgery combined with saphenous vein ablation: results and critical analysis [J]. J Vasc Surg, 2003; 38(1): 67-71.

1. Taheri SA, Lazar L, Elias S, et al. Surgical treatment of postphlebitic syndrome with vein valve transplant [J]. Am J Surg, 1982; 144(2): 221-224.
2. Schanzer H, Peirce EC 2nd. A rational approach to surgery of the chronic venous statis syndrome 　[J]. Ann Surg, 1982; 195(1): 25-29.
3. Meissner MH, Eklof B, Smith PC, et al. Secondary chronic venous disorders [J]. J Vasc Surg, 2007; 46 Suppl S: 68S-83S.
4. Meissner MH, Gloviczki P, Bergan J, et al. Primary chronic venous disorders [J]. J Vasc Surg, 2007; 46 Suppl S: 54S-67S.
5. Belcaro G, Labropoulos N, Christopoulos D, et al. Noninvasive tests in venous insufficiency [J]. J Cardiovasc Surg (Torino), 1993; 34(1): 3-11.
6. Schultheiss R, Billeter M, Bollinger A, et al. Comparison between clinical examination, cw-Doppler ultrasound and colour-duplex sonography in the diagnosis of incompetent perforating veins [J]. Eur J Vasc Endovasc Surg, 1997; 13(2): 122-126.
7. van Rij AM, Jiang P, Solomon C, et al. Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography [J]. J Vasc Surg, 2003; 38(5): 935-943.
8. Pichot O, Kabnick LS, Creton D, et al. Duplex ultrasound scan findings two years after great saphenous vein radiofrequency endovenous obliteration [J]. J Vasc Surg, 2004; 39(1): 189-195.
9. Puggioni A, Lurie F, Kistner RL, et al. How often is deep venous reflux eliminated after saphenous vein ablation? [J]. J Vasc Surg, 2003; 38(3): 517-521.
10. Padberg FT Jr, Pappas PJ, Araki CT, et al. Hemodynamic and clinical improvement after superficial vein ablation in primary combined venous insufficiency with ulceration [J]. J Vasc Surg, 1996; 24(5): 711-718.
11. Ting AC, Cheng SW, Wu LL, et al. Changes in venous hemodynamics after superficial vein surgery for mixed superficial and deep venous insufficiency [J]. World J Surg, 2001; 25(2): 122-125.
12. Makarova NP, Lurie F, Hmelniker SM. Does surgical correction of the superficial femoral vein valve change the course of varicose disease? [J]. J Vasc Surg, 2001; 33(2): 361-368.
13. Tripathi R, Sieunarine K, Abbas M, et al. Deep venous va-lve reconstruction for non-healing leg ulcers: techniques and results [J]. ANZ J Surg, 2004; 74(1-2): 34-39.
14. 王深明. 下肢慢性靜脈功能不全外科治療的現狀與爭議 [J]. 外科理論與實踐， 2005； 10(1): 4-7.
15. 陸民. 外科手術在治療慢性靜脈功能不全中的作用 [J]. 臨床外科雜志, 2008; 16(5): 299-301.
16. Toporcer T, Lakyová L, Radonak J. Venous ulcer－present view on aetiology, diagnostics and therapy [J]. Cas Lek Cesk, 2008; 147(4): 199-205.
17. 王深明，胡作軍，李曉曦，等. 內鏡筋膜下交通靜脈結扎術治療重度慢性下肢靜脈功能不全51例 [J]. 中華普通外科雜志, 2003； 18(9): 527-529.
18. Bianchi C, Ballard JL, Abou-Zamzam AM, et al. Subfascial endoscopic perforator vein surgery combined with saphenous vein ablation: results and critical analysis [J]. J Vasc Surg, 2003; 38(1): 67-71.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Recognition on Surgical Treatment of Chronic Venous Insufficiency in Lower Limb at Present

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