局部股神经阻滞下大隐静脉曲张外科治疗(1)
摘 要：目的 分析海拔4300米高原低氧条件下，局部股神经阻滞麻醉下大隐静脉曲张高位结扎、主干剥脱手术的麻醉效果。方法 选择西藏阿里地区人民医院2016年1月～2017年12月收治的成人大隐静脉曲张患者62例，腹股沟区注射罗哌卡因局部麻醉并阻滞股神经，腹股沟及内踝处分别结扎大隐静脉并剥脱主干，观察手术时间及治疗效果。结果 所有患者手术顺利，治疗效果满意，平均手术时间(45.01±13.12)min，术后即可饮食，术后第1天下床活动，未发生伤口红肿、渗出及深静脉血栓等并发症，平均术后(3.20±0.51)d出院，均治愈。结论 罗哌卡因局部股神经阻滞麻醉下大隐静脉曲张高位结扎加主干剥脱治疗静脉曲张，麻醉及手术操作简单、安全性高、创伤小、恢复快，效果确切等，值得应用。
关键词：神经阻滞；股神经；大隐静脉曲张
中图分类号：R614.4 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.17.059
, 百拇医药
文章编号：1006-1959(2018)17-183-02
Abstract：Objective To analyze the anesthetic effect of high saphenous vein variceal ligation and main exfoliation under local anesthesia with local femoral nerve block under altitude of 4300 meters.Methods 62 adult patients with saphenous varices were enrolled from January 2016 to December 2017 in the Ali District People's Hospital of Tibet.Local anesthesia with ropivacaine was injected into the inguinal region and the femoral nerve was blocked.The inguinal and medial malleolus were ligated.The vein was exfoliated and the main operation was observed to observe the operation time and treatment effect.Results All patients underwent successful operation and satisfactory treatment.The average operation time was(45.01±13.12)min.After the operation，the patient was able to get out of bed on the first day after operation.No complications such as redness，exudation and deep vein thrombosis occurred.The average postoperative(3.20±0.51)d was discharged and all were cured.Conclusion Ropivacaine with local femoral nerve block anesthesia with high saphenous vein variceal ligation and main exfoliation for varicose veins，anesthesia and surgical operation is simple，safe，low trauma，quick recovery，exact effect，etc.，worthy of application.
, 百拇医药
Key words：Nerve block；Femoral nerve；Saphenous vein varicose
高原地區人体负荷较重，从事站立工作或重负荷劳动可以使下肢血管变直，同时肌肉的挤压作用减小，下肢血液回流减慢，下肢静脉内压力增高，引起下肢静脉曲张。未及时治疗，严重者可导致浅静脉血栓或曲张静脉破裂出血[1]，严重影响患者的生活质量。上世纪以来，大隐静脉高位结扎剥脱术一直是治疗大隐静脉曲张的经典手术方式，一般情况在椎管麻醉下进行。王明等[2]提出，应用局部阻滞麻醉股神经可达到与椎管内麻醉相同的效果。本研究选择西藏阿里地区人民医院2016年1月～2017年12月收治的大隐静脉曲张患者62例，行罗哌卡因局部麻醉并股神经阻滞下大隐静脉高位结扎剥脱术，现报告如下。
1 资料与方法
1.1一般资料 选择西藏阿里地区人民医院2016年1月～2017年12月收治的成人大隐静脉曲张患者62例，患者年龄27～71岁，平均年龄(45.27±1.60)岁。左下肢27例，右下肢35例，其中合并浅静脉炎2例，伴有皮肤湿疹3例，静脉曲张合并色素沉着9例。主要临床表现是下肢浅静脉明显迂曲、扩张，伴有长久站立活动后下肢酸胀不适，病程较长的患者常伴有不同程度的靴区皮肤发黑，皮肤瘙痒、甚至溃烂不愈。一般根据病史及临床表现即可确定诊断。可行下肢静脉彩色多普勒检查，根据静脉血流色彩的变化判断静脉血流有无反流[3]。当怀疑有深静脉病变时，往往行顺行或逆行下肢静脉造影[4]。
1.2麻醉及手术方法 患者平卧手术台上，患侧下肢稍外展并足向外旋，于腹股沟韧带中点下方触摸股动脉搏动并做标记。常规皮肤消毒后铺巾，于腹股沟区标记处内侧约1.5 cm处，用0.5%罗哌卡因2～3 ml逐层局部浸润麻醉：再于股动脉标记处外侧约1.0 cm处用7号注射用针头穿刺，注入0.5%罗哌卡因8～10 ml阻滞股神经。患肢完全消毒后铺巾，于腹股沟区股动脉标记处内侧约1.5 cm处，大隐静脉汇入股静脉处皮肤切0.5 cm切口高位结扎大隐静脉根部；再于内踝处结扎大隐静脉远端，将静脉剥脱器经踝部大隐静脉置入至股部大隐静脉断端穿出，结扎血管两端于剥脱器上，从股部牵拉剥脱器，将大隐静脉主干全段剥离，缝合伤口并用弹力绷带包扎整个患肢。, http://www.100md.com(李武军 陈莉 贡桑名久)
关键词：神经阻滞；股神经；大隐静脉曲张
中图分类号：R614.4 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.17.059
, 百拇医药
文章编号：1006-1959(2018)17-183-02
Abstract：Objective To analyze the anesthetic effect of high saphenous vein variceal ligation and main exfoliation under local anesthesia with local femoral nerve block under altitude of 4300 meters.Methods 62 adult patients with saphenous varices were enrolled from January 2016 to December 2017 in the Ali District People's Hospital of Tibet.Local anesthesia with ropivacaine was injected into the inguinal region and the femoral nerve was blocked.The inguinal and medial malleolus were ligated.The vein was exfoliated and the main operation was observed to observe the operation time and treatment effect.Results All patients underwent successful operation and satisfactory treatment.The average operation time was(45.01±13.12)min.After the operation，the patient was able to get out of bed on the first day after operation.No complications such as redness，exudation and deep vein thrombosis occurred.The average postoperative(3.20±0.51)d was discharged and all were cured.Conclusion Ropivacaine with local femoral nerve block anesthesia with high saphenous vein variceal ligation and main exfoliation for varicose veins，anesthesia and surgical operation is simple，safe，low trauma，quick recovery，exact effect，etc.，worthy of application.
, 百拇医药
Key words：Nerve block；Femoral nerve；Saphenous vein varicose
高原地區人体负荷较重，从事站立工作或重负荷劳动可以使下肢血管变直，同时肌肉的挤压作用减小，下肢血液回流减慢，下肢静脉内压力增高，引起下肢静脉曲张。未及时治疗，严重者可导致浅静脉血栓或曲张静脉破裂出血[1]，严重影响患者的生活质量。上世纪以来，大隐静脉高位结扎剥脱术一直是治疗大隐静脉曲张的经典手术方式，一般情况在椎管麻醉下进行。王明等[2]提出，应用局部阻滞麻醉股神经可达到与椎管内麻醉相同的效果。本研究选择西藏阿里地区人民医院2016年1月～2017年12月收治的大隐静脉曲张患者62例，行罗哌卡因局部麻醉并股神经阻滞下大隐静脉高位结扎剥脱术，现报告如下。
1 资料与方法
1.1一般资料 选择西藏阿里地区人民医院2016年1月～2017年12月收治的成人大隐静脉曲张患者62例，患者年龄27～71岁，平均年龄(45.27±1.60)岁。左下肢27例，右下肢35例，其中合并浅静脉炎2例，伴有皮肤湿疹3例，静脉曲张合并色素沉着9例。主要临床表现是下肢浅静脉明显迂曲、扩张，伴有长久站立活动后下肢酸胀不适，病程较长的患者常伴有不同程度的靴区皮肤发黑，皮肤瘙痒、甚至溃烂不愈。一般根据病史及临床表现即可确定诊断。可行下肢静脉彩色多普勒检查，根据静脉血流色彩的变化判断静脉血流有无反流[3]。当怀疑有深静脉病变时，往往行顺行或逆行下肢静脉造影[4]。
1.2麻醉及手术方法 患者平卧手术台上，患侧下肢稍外展并足向外旋，于腹股沟韧带中点下方触摸股动脉搏动并做标记。常规皮肤消毒后铺巾，于腹股沟区标记处内侧约1.5 cm处，用0.5%罗哌卡因2～3 ml逐层局部浸润麻醉：再于股动脉标记处外侧约1.0 cm处用7号注射用针头穿刺，注入0.5%罗哌卡因8～10 ml阻滞股神经。患肢完全消毒后铺巾，于腹股沟区股动脉标记处内侧约1.5 cm处，大隐静脉汇入股静脉处皮肤切0.5 cm切口高位结扎大隐静脉根部；再于内踝处结扎大隐静脉远端，将静脉剥脱器经踝部大隐静脉置入至股部大隐静脉断端穿出，结扎血管两端于剥脱器上，从股部牵拉剥脱器，将大隐静脉主干全段剥离，缝合伤口并用弹力绷带包扎整个患肢。, http://www.100md.com(李武军 陈莉 贡桑名久)