Blomgren L, Johansson G, Bergqvist D
Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden.
Br J Surg. 2005 Jun;92(6):688-94. doi: 10.1002/bjs.4983.
Duplex imaging is used increasingly for preoperative evaluation of varicose veins, but its value in terms of the long-term results of surgery is not clear.
Patients with primary varicose veins were randomized to operation with or without preoperative duplex imaging. Reoperation rates, clinical and duplex findings were compared at 2 months and 2 years after surgery.
Two hundred and ninety-three patients (343 legs) had varicose vein surgery after duplex imaging (group 1; 166 legs) or no imaging (group 2; 177 legs). In 44 legs (26.5 per cent), duplex examination suggested a different surgical procedure than had been considered on clinical grounds; the procedure was changed accordingly for 29 legs. At 2 months, incompetence was detected at the saphenofemoral or saphenopopliteal junction (or both) in 14 legs (8.8 per cent) in group 1 and in 44 legs (26.5 per cent) in group 2 (P < 0.001). At 2 years, two legs (1.4 per cent) had undergone or were awaiting reoperation in group 1, and 14 legs (9.5 per cent) in group 2 (P = 0.002). In the remainder, major incompetence was found in 19 legs (15.0 per cent) in group 1 and in 53 (41.1 per cent) in group 2 (P < 0.001).
Routine preoperative duplex examination led to an improvement in results 2 years after surgery for patients with primary varicose veins.
双功超声成像越来越多地用于静脉曲张的术前评估，但其对手术长期效果的价值尚不清楚。
将原发性静脉曲张患者随机分为术前接受或未接受双功超声成像检查后进行手术的两组。比较术后2个月和2年时的再次手术率、临床及双功超声检查结果。
293例患者（343条腿）接受了静脉曲张手术，其中一组（166条腿）术前接受了双功超声成像检查，另一组（177条腿）未接受检查。在44条腿（26.5%）中，双功超声检查提示的手术方式与基于临床判断的不同；其中29条腿相应地改变了手术方式。术后2个月时，第1组14条腿（8.8%）在隐股或隐腘静脉交界处（或两处）发现瓣膜功能不全，第2组44条腿（26.5%）出现该情况（P<0.001）。术后2年时，第1组有2条腿（1.4%）接受了再次手术或等待再次手术，第2组有14条腿（9.5%）（P=0.002）。其余患者中，第1组19条腿（15.0%）发现有严重瓣膜功能不全，第2组53条腿（41.1%）出现该情况（P<0.001）。
对于原发性静脉曲张患者，术前常规进行双功超声检查可改善术后2年的治疗效果。
