Yamamoto Naoto, Unno Naoki, Mitsuoka Hiroshi, Saito Takaaki, Miki Keita, Ishimaru Kei, Kaneko Hiroshi, Nakamura Satoshi
Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, Japan 431-3192.
J Vasc Surg. 2002 Dec;36(6):1225-30. doi: 10.1067/mva.2002.128941.
Interruption of incompetent perforating veins (PVs) is important for varicose vein surgery. The purpose of this study was to evaluate the preoperative and intraoperative diameter-reflux relationship of PVs and to evaluate the accuracy of preoperative duplex scanning in patients with varicose vein.
Patients with primary varicose veins were retrospectively investigated. Diameters and reflux of PVs were evaluated before surgery with color flow duplex ultrasound scan (US). During operation, the incompetent PVs were defined as those that showed an outward spurt of blood flow from the stump of the PVs. The sensitivity and specificity of US in the detection of reflux of PVs were calculated. Competent versus incompetent vein diameters were compared with the Student t test and one-way analysis of variance.
Three hundred twenty-four calf PVs were detected in 304 legs of 175 patients with varicose vein. Diameters of competent and incompetent PVs confirmed with intraoperative finding averaged 2.67 +/- 1.10 mm (n = 28) and 3.28 +/- 1.01 mm (n = 58), respectively, at the upper calf (P =.012), 2.85 +/- 0.85 mm (n = 53) and 3.68 +/- 0.94 mm (n = 137), respectively, at the lower calf (p <.001), and 2.67 +/- 0.99 mm (n = 14) and 3.27 +/- 0.66 mm (n = 22), respectively, at the posterior calf (P =.036). The overall sensitivity of detection of reflux with US was 87.7%, and the specificity was 75.3%. Diameters of true-incompetent PVs and false-incompetent PVs were 3.59 +/- 0.94 mm (n = 199) and 3.31 +/- 0.84 mm (n = 24), respectively (P =.157). Diameters of true-competent PVs and false-competent PVs were 2.61 +/- 0.91 mm (n = 73) and 2.89 +/- 0.82 mm (n = 28), respectively (P =.158).
Although the diameter of incompetent PVs was larger than that of competent PVs in both US and intraoperative findings, diameter measurement alone can not completely distinguish competent and incompetent PVs. The sensitivity and specificity of reflux obtained with US showed that the accuracy of preoperative duplex scanning to evaluate PV competency was not sufficient.
阻断功能不全的穿静脉（PVs）对于静脉曲张手术很重要。本研究的目的是评估PVs术前和术中直径与反流的关系，并评估术前双功超声扫描对静脉曲张患者的准确性。
对原发性静脉曲张患者进行回顾性研究。术前用彩色血流双功超声扫描（US）评估PVs的直径和反流情况。手术中，将功能不全的PVs定义为PVs残端有血流向外喷射的那些。计算US检测PVs反流的敏感性和特异性。用Student t检验和单因素方差分析比较功能正常与功能不全静脉的直径。
在175例静脉曲张患者的304条腿中检测到324条小腿PVs。术中发现证实的功能正常和功能不全的PVs直径，在上小腿平均分别为2.67±1.10mm（n = 28）和3.28±1.01mm（n = 58）（P = 0.012），在下小腿分别为2.85±0.85mm（n = 53）和3.68±0.94mm（n = 137）（p < 0.001），在后小腿分别为2.67±0.99mm（n = 14）和3.27±0.66mm（n = 22）（P = 0.036）。US检测反流的总体敏感性为87.7%，特异性为75.3%。真正功能不全的PVs和假功能不全的PVs直径分别为3.59±0.94mm（n = 199）和3.31±0.84mm（n = 24）（P = 0.157）。真正功能正常的PVs和假功能正常的PVs直径分别为2.61±0.91mm（n = 73）和2.89±0.82mm（n = 28）（P = 0.158）。
尽管在超声检查和术中发现中，功能不全的PVs直径均大于功能正常的PVs，但仅靠直径测量不能完全区分功能正常和功能不全的PVs。超声检查获得的反流敏感性和特异性表明，术前双功超声扫描评估PVs功能的准确性不足。
