1、周圍血管疾病講義血管外科2NO3NO334567891011121314151617181920212223242526272829303132333435363738394041 尚不清楚 易患因素：年齡45歲，糖尿病、高脂血 癥、吸煙、高血壓等病變部位：腹主動脈，髂、股動脈，月國 動脈及分叉部424344454647484950515253l經皮血管腔內成形術（經皮血管腔內成形術（Percutaneous Transluminal Angioplasty, PTA)l經皮血管腔內支架經皮血管腔內支架(Stent)置入術置入術545556575859606162636465666768697

2、071727374757677787980818283848586878889909192939495前沿進展前沿進展 目前原發性大隱靜脈曲張外科治療主要向微創化治療目前原發性大隱靜脈曲張外科治療主要向微創化治療發展，外科治療原則是高位結扎大隱靜脈，剝脫曲張靜脈發展，外科治療原則是高位結扎大隱靜脈，剝脫曲張靜脈，結扎或破壞交通靜脈。主要治療手段為大隱靜脈高位結，結扎或破壞交通靜脈。主要治療手段為大隱靜脈高位結扎和曲張大隱靜脈點式剝脫術，新近也采用大隱靜脈激光扎和曲張大隱靜脈點式剝脫術，新近也采用大隱靜脈激光，射頻，電凝閉塞主干，曲張大隱靜脈旋切手術，但遠期，射頻，電凝閉塞主干，曲張大隱靜脈旋切

3、手術，但遠期療效尚待進一步觀察療效尚待進一步觀察。 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患肢淺靜脈擴張、彎曲、甚至蜷曲成團伴色素沉著、脫屑、瘙癢、濕疹和潰瘍患肢淺靜脈擴張、彎曲、甚至蜷曲成團伴色素沉著、脫屑、瘙癢、濕疹和潰瘍lerthe試驗（深靜脈通暢試驗）和（試驗（深靜脈通暢試驗）和（Trendelenberg）試驗（大隱靜脈瓣）試驗（大隱靜脈瓣膜功能試驗）膜功能試驗）l 彩色多普勒超聲或靜脈造影檢查深靜脈通暢和返流彩色多普勒超聲或靜脈造影檢查深靜脈通暢和返流l原發性下肢靜脈曲張原發性下肢靜脈曲張 繼發性下肢靜脈曲張繼發性下肢靜脈曲張（深靜脈通暢和無返流）（深靜脈通暢和無返流） （深靜脈阻塞或有返流（深靜脈阻塞或有返流)（鑒別診斷）（鑒別