Long-term results of vein sparing varicose vein surgery
Long-term results of vein sparing varicose vein surgery
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保留静脉的静脉曲张手术的长期结果
DOI：
10.1007/s00268-002-6375-8
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发表时间：
2002
影响因子：
2.6
通讯作者：
A. Lehtola
中科院分区：
文献类型：
--
作者：
P. Raivio;V. Perhoniemi;A. Lehtola
本研究的目的是评估使用手持式多普勒超声 (HHD) 保留静脉的曲张静脉手术的长期功能结果。该系列由 171 名连续接受日间手术的无并发症下肢静脉曲张患者组成。根据临床检查和 HHD，被认为有能力的静脉段被保留，仅在外科医生认为有必要时才在术前进行。平均随访 8 年后，对所有患者进行检查，进行系统的 HHD 评估，根据 CEAP（临床、病因学、解剖学、病理生理学）分类对结果进行分类，并进行残疾评分。在随访期间，17%的腿部接受了再次手术或计划再次手术。随访时，79% 的患者没有症状，无需再次手术。 24% 的患者存在复发性静脉曲张，HHD 证实存在静脉回流。当隐股交界处最初保持完整时，复发率是原来的两倍。在所有复发病例中，62%出现在膝部以上的长隐静脉（LSV），7%出现在膝部以下的LSV，16%出现在短隐静脉（SSV），38%出现在后弓静脉，8%出现在大腿穿支。在随访期间再次手术的腿部中，41% 在随访时出现静脉回流。我们的结论是，HHD 有效地揭示了先前手术中遗漏的反流部位，并且需要进行彻底的术前 HHD 检查并标记反流路径。
The aim of this study was to assess the long-term functional outcome of vein sparing varicose vein surgery using handheld Doppler ultrasound (HHD). The series consisted of 171 consecutive day-case surgery patients operated on for uncomplicated lower limb varicose veins. Venous segments considered competent were spared based on clinical examination and HHD, which was performed preoperatively only when deemed necessary by the surgeon. After a mean follow-up of 8 years all patients were examined, a systematic HHD evaluation was performed, and the findings were classified according to the CEAP (Clinical, Etiological, Anatomical, Pathophysiological) classification, and disability scoring was performed. During the follow-up period 17% of the legs were reoperated or scheduled for reoperation. At follow-up 79% of all patients were asymptomatic without reoperation. In 24%, recurrent varicosities were present and venous reflux was demonstrated by HHD. Recurrence was two times more common when the saphenofemoral junction had originally been left intact. Of all recurrent cases, reflux was demonstrated in the long saphenous vein (LSV) above the knee in 62%, in the LSV below the knee in 7%, in the short saphenous vein (SSV) in 16%, in the posterior arch vein in 38%, and in a thigh perforator in 8%. Of the legs reoperated during the follow-up period 41% presented with venous reflux at the follow-up visit. We conclude that HHD efficiently reveals sites of reflux that have been missed during previous surgery and that a thorough preoperative HHD examination and marking of reflux routes is required.