Bhatti T S, Whitman B, Harradine K, Cooke S G, Heather B P, Earnshaw J J
Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
Br J Surg. 2000 Oct;87(10):1356-60. doi: 10.1046/j.1365-2168.2000.01602.x.
The aim of this study was to determine whether a polytetrafluoroethylene (PTFE) patch sutured over the religated saphenofemoral junction could reduce the rate of recurrence after operation for recurrent varicose veins.
Fifty patients who had surgery for recurrent long saphenous incompetence (81 legs had a small PTFE patch sutured over the religated saphenofemoral junction. There were no major complications following surgery. Three patients had a wound infection or delayed healing. All patients were invited for clinical examination and duplex imaging at a median of 19 (range 6-39) months after operation.
Some 38 of 43 patients (70 legs) remained satisfied with the results of surgery; 16 (23 per cent) of 70 legs had visible veins on inspection and eight of these (11 per cent) involved symptomatic recurrence. Duplex imaging showed that recurrence was due to saphenofemoral junction incompetence in ten legs; two appeared to have a major groin connection but the other eight appeared to have neovascularization. Other causes were thigh perforator reflux (three legs) and cross-groin collaterals (three). Eleven of the 16 legs with recurrence had varicography but in two the procedure was a technical failure. Two legs had evidence of a significant connection (more than 3 mm) and two a minor connection (less than 3 mm) to the femoral vein at the level of the PTFE patch, but in the remainder recurrence was due to upper thigh perforating veins. There was good concordance between duplex imaging and varicography.
PTFE patch saphenoplasty appears to be safe. Although these are early results, the technique seems potentially as effective as other barrier methods that have been investigated; in ten legs (12 per cent) recurrence was attributed to failure at the level of the PTFE patch.
本研究的目的是确定在重新结扎的隐股静脉交界处缝合聚四氟乙烯（PTFE）补片是否能降低复发性静脉曲张手术后的复发率。
50例因复发性大隐静脉功能不全接受手术的患者（81条腿），在重新结扎的隐股静脉交界处缝合了一小块PTFE补片。术后无重大并发症。3例患者出现伤口感染或愈合延迟。所有患者均在术后中位时间19个月（范围6 - 39个月）接受临床检查和双功超声成像检查。
43例患者中的38例（70条腿）对手术结果仍感到满意；70条腿中有16条（23%）在检查时可见静脉，其中8条（11%）出现症状性复发。双功超声成像显示，10条腿的复发是由于隐股静脉交界处功能不全；2条腿似乎有主要的腹股沟连接，但另外8条腿似乎是新生血管形成。其他原因包括大腿穿通支反流（3条腿）和跨腹股沟侧支循环（3条腿）。16条复发腿中有11条进行了静脉造影，但2例操作失败。2条腿在PTFE补片水平与股静脉有明显连接（超过3 mm），2条腿有轻微连接（小于3 mm），但其余复发是由于大腿上段穿通静脉。双功超声成像和静脉造影之间有良好的一致性。
PTFE补片隐静脉成形术似乎是安全的。尽管这些是早期结果，但该技术似乎可能与其他已研究的屏障方法一样有效；10条腿（12%）的复发归因于PTFE补片水平的失败。
