病理性穿通支静脉的诊治进展

Advances in diagnosis and treatment of pathologic perforating veins

摘要:

穿通支静脉连接下肢深、浅静脉系统，在维持浅静脉向深静脉单向回流中发挥重要作用。当穿通支静脉瓣膜功能不全时，可导致深静脉向浅静脉反流，引起浅静脉高压，进而诱发静脉曲张、皮肤色素沉着、湿疹及静脉性溃疡等一系列慢性静脉疾病表现。研究表明，病理性穿通支静脉（PPV）与下肢静脉性溃疡的发生和愈合密切相关，也是静脉曲张术后复发的重要因素之一。然而，对于多数以浅静脉反流为主的静脉曲张患者，同期干预穿通支静脉是否能够带来额外获益，仍存在争议。近年来，影像学诊断技术及微创治疗手段的不断发展，使PPV的识别和治疗策略逐渐多样化。本文围绕PPV的生理与病理机制、解剖学特点、诊断方法及治疗进展进行综述，旨在为临床合理评估和个体化治疗提供参考。

Abstract:

Perforating veins connect the deep and superficial venous systems of the lower extremities and play a crucial role in maintaining unidirectional blood flow from the superficial to the deep veins. Incompetence of perforating vein valves may result in reflux from the deep to the superficial venous system, leading to elevated superficial venous pressure and subsequent pathological changes, including varicose veins, skin pigmentation, dermatitis, and venous ulcers. Accumulating evidence suggests that pathological perforating veins (PPVs) are closely associated with the development and delayed healing of lower extremity venous ulcers and represent an important contributor to postoperative recurrence of varicose veins. However, whether routine concomitant treatment of perforating veins provides additional clinical benefits in patients primarily treated for superficial venous reflux remains controversial. With advances in imaging techniques and minimally invasive therapies, diagnostic accuracy and treatment options for PPVs have expanded substantially. This review summarizes the current understanding of the pathophysiology, anatomical characteristics, diagnostic approaches, and therapeutic advances in PPVs, aiming to provide clearer guidance for clinical decision-making and individualized management.