Boítsov N I, Evtikhov R M, Potapov N A
Department of Surgical Diseases, State Medical Institute, Ivanovo.
Khirurgiia (Mosk). 1997(8):57-60.
Functional conditions of the muscular-venous pump of the shin were studied in 280 patients with varicose veins before surgery, in 164 patients in remote terms after various operations and in 54 healthy subjects on the base of guantitative plethysmographic estimation of hemodynamic parameters. At the stage of compensation all volume indices of the bloodflow were close to normal values; in the stage of decompensation the substantial increase of volume effectiveness and volume flow velocity was observed at carrying out the test for direct deep blood flow when walking. It was determined that in natural condition for venous hemodynamics the adaptation mechanisms of musculo-venous pump were not realized. The operation of Linton upsets the function of musculo-venous pump of the shin. The Kocket operation does not eliminate the pathologic overload when working due to insufficient radicalism in liquidation of perforation escape (steal phenomena). The subfascial ligation of perforating veins of the shin through the minor approach, used in clinical practice, proved to be sufficiently radical and does not impair the function of the musculo-venous pump of the shin.
在280例静脉曲张患者术前、164例接受各种手术后远期的患者以及54名健康受试者中,基于血流动力学参数的定量体积描记法评估,研究了小腿肌肉-静脉泵的功能状况。在代偿阶段,所有血流的容积指标均接近正常值;在失代偿阶段,步行时进行直接深血流测试时,观察到容积效率和容积流速大幅增加。已确定,在静脉血流动力学的自然状态下,肌肉-静脉泵的适应机制未得到实现。林顿手术会扰乱小腿肌肉-静脉泵的功能。由于在消除穿孔逃逸(盗血现象)方面不够彻底,科克特手术在工作时无法消除病理性过载。临床实践中采用的经小切口对小腿穿通静脉进行筋膜下结扎,已被证明足够彻底,且不会损害小腿肌肉-静脉泵的功能。