Aschberg S, Ankarcrona H, Bergstrand O, Björkholm M
Acta Chir Scand. 1976;142(8):585-7.
A modification of the Palma operation is described in a 25-year-old man with impaired venous outflow of the right leg. After a phlebitic occlusion of the right superficial femoral and external iliac veins he had been operated on twice for varicose veins. The result of these operations was a serious outflow stasis of the right leg during exercise. A saphenous cross-over graft to the right popliteal vein was constructed. Preoperatively a temporary arterio-venous shunt between the left posterior tibial artery and the great saphenous vein had been made in order to increase the diameter of the saphenous vein. Three months later the dilated saphenous vein was resected at the level of the sapheno-tibial artery shunt and anastomosed to the popliteal vein of the right leg. The cross-over graft occluded several times during this operation. A temporary popliteo-popliteal arterio-venous shunt was established distally to the sapheno-popliteal anastomosis to keep the vein graft patent. This second arterio-venous shunt was resected after three months. Venography one month later showed that the vein graft was patent. The patient's complaints had disappeared one month after the operation and a normalization of his venous outflow was recorded plethysmographically. The graft has remained patent during an observation time of eighteen months.
本文描述了对一名25岁男性患者实施的改良帕尔马手术，该患者右腿静脉回流受损。在右侧股浅静脉和髂外静脉发生血栓闭塞后，他曾因静脉曲张接受过两次手术。这些手术的结果是，患者在运动时右腿出现严重的血液流出淤滞。于是构建了一条隐静脉交叉移植至右侧腘静脉。术前，在左胫后动脉和大隐静脉之间建立了一个临时动静脉分流，以增加隐静脉的直径。三个月后，在隐胫动脉分流水平切除扩张的隐静脉，并与右腿的腘静脉进行吻合。在这次手术过程中，交叉移植血管多次闭塞。在隐腘静脉吻合口远端建立了一个临时腘腘动静脉分流，以保持静脉移植血管通畅。三个月后切除了这第二个动静脉分流。术后一个月的静脉造影显示静脉移植血管通畅。术后一个月患者的症状消失，体积描记法记录显示其静脉流出恢复正常。在18个月的观察期内，移植血管一直保持通畅。
