周围血管疾病讲义血管外科

1、周围血管疾病讲义血管外科2NO3NO334567891011121314151617181920212223242526272829303132333435363738394041 尚不清楚 易患因素：年龄45岁，糖尿病、高脂血 症、吸烟、高血压等病变部位：腹主动脉，髂、股动脉，月国 动脉及分叉部424344454647484950515253l经皮血管腔内成形术（经皮血管腔内成形术（Percutaneous Transluminal Angioplasty, PTA)l经皮血管腔内支架经皮血管腔内支架(Stent)置入术置入术545556575859606162636465666768697

2、071727374757677787980818283848586878889909192939495前沿进展前沿进展 目前原发性大隐静脉曲张外科治疗主要向微创化治疗目前原发性大隐静脉曲张外科治疗主要向微创化治疗发展，外科治疗原则是高位结扎大隐静脉，剥脱曲张静脉发展，外科治疗原则是高位结扎大隐静脉，剥脱曲张静脉，结扎或破坏交通静脉。主要治疗手段为大隐静脉高位结，结扎或破坏交通静脉。主要治疗手段为大隐静脉高位结扎和曲张大隐静脉点式剥脱术，新近也采用大隐静脉激光扎和曲张大隐静脉点式剥脱术，新近也采用大隐静脉激光，射频，电凝闭塞主干，曲张大隐静脉旋切手术，但远期，射频，电凝闭塞主干，曲张大隐静脉旋切

3、手术，但远期疗效尚待进一步观察疗效尚待进一步观察。 96l Primary varicose vein of lower extremities: superficial vessel that is abnormally lengthened, twisted, or dilated, seen most often on the legs and thighs. Varicose veins develop spontaneously, and are usually attributed to a hereditary weakness of the vein; the valves i

4、n the vein that keep the blood circulating upward toward the heart are usually incompetent. Increased pressure from long standing or exertion, or internal factors such as pregnancy, or lessened support by the tissues surrounding the veins that occurs with aging and obesity causes the weakened veins

5、to dilate. Mild varicosities often cause no discomfort. Persons with more severe cases may develop swelling of the legs, ankles, and feet, and local eczema or ulcers. Mild varicosities may be treated with rest, elevation of the legs, and the use of elastic bandages or stockings. In severe cases surg

6、ical treatment may be necessary.97l患肢浅静脉扩张、弯曲、甚至蜷曲成团伴色素沉着、脱屑、瘙痒、湿疹和溃疡患肢浅静脉扩张、弯曲、甚至蜷曲成团伴色素沉着、脱屑、瘙痒、湿疹和溃疡lerthe试验（深静脉通畅试验）和（试验（深静脉通畅试验）和（Trendelenberg）试验（大隐静脉瓣）试验（大隐静脉瓣膜功能试验）膜功能试验）l 彩色多普勒超声或静脉造影检查深静脉通畅和返流彩色多普勒超声或静脉造影检查深静脉通畅和返流l原发性下肢静脉曲张原发性下肢静脉曲张 继发性下肢静脉曲张继发性下肢静脉曲张（深静脉通畅和无返流）（深静脉通畅和无返流） （深静脉阻塞或有返流（深静脉阻塞或有返流)（鉴别诊断）（鉴别