Irace L, Siani A, Laurito A, Cappello F, Brunetti M, Tozzi M
II Cattedra di Chirurgia Vascolare, Università degli Studi La Sapienza, Rome, Italy.
Minerva Cardioangiol. 2001 Dec;49(6):383-7.
The aim of surgical therapy of varicose veins is the elimination of reflux from the deep to superficial system at the saphenous crosse and perforant vessel and conservation of the superficial venous system due to possible surgical procedures for arterial revascularization. This latter condition leads to an extension of indications for short stripping procedures, although the venous distal segment may undergo hypoplastic degeneration not compatible for revascularization purposes. Another important reason is the minor incidence of neurologic complication due to saphenous nerve lesion which may occur during long saphenous stripping.
From January 1994 to June 1999, we considered 233 patients (182 women, 51 men); 180 cases underwent long saphenous stripping procedures, whereas 53 a short stripping of GSV. The incidence of neurologic complications of the saphenous nerve were recorded in 11.6% of the patients treated with the standard procedure, whereas no such complication was observed in all cases treated with the short stripping procedure.
ECD follow-up performed for a period of three months from the surgical procedure revealed the patency of the residual saphenous vein, with a minimum diameter of 3 mm, in 28 patients (56.6%).
Our opinion is to extend the indication for short stripping of the saphenous vein to all cases where the distal saphenous trunk is not involved, when the ECD shows a pathological ostial reflux, a truncular reflux limited to the thigh, which may be associated with incontinence of the perforant vein of Dodd.
静脉曲张手术治疗的目的是消除隐静脉交叉处和穿支血管从深静脉系统到浅静脉系统的反流,并因可能进行的动脉血运重建手术而保留浅静脉系统。后一种情况导致短剥脱术适应证的扩大,尽管静脉远端段可能发生发育不全性退变,不适合进行血运重建。另一个重要原因是大隐静脉剥脱术中可能发生的隐神经损伤导致的神经并发症发生率较低。
1994年1月至1999年6月,我们纳入了233例患者(182例女性,51例男性);180例行大隐静脉长剥脱术,53例行大隐静脉短剥脱术。记录隐神经神经并发症的发生率,标准手术治疗的患者中有11.6%发生该并发症,而短剥脱术治疗的所有病例均未观察到此类并发症。
手术后三个月进行的ECD随访显示,28例患者(56.6%)残留隐静脉通畅,最小直径为3mm。
我们认为,当ECD显示病理性开口反流、仅限于大腿的主干反流,且可能与多德穿支静脉失禁相关时,大隐静脉短剥脱术的适应证应扩大到所有远端隐静脉主干未受累的病例。