Hulusi Melih, Ozbek Cihan, Basaran Murat, Ucak Alper, Sanioglu Soner, Arslan Yucesin, Ogus Timucin, Kaya Kaya Zafer, Yilmaz Ahmet Turan
Cardiovascular Surgery Department, Turkey.
Surgery. 2006 May;139(5):640-5. doi: 10.1016/j.surg.2005.09.014.
Patients who had undergone complete ankle-to-groin stripping of the greater saphenous vein were evaluated retrospectively to assess the necessity of saphenofemoral junction reconstruction during the stripping procedure. Since 1996, in addition to the conventional complete stripping operation, we routinely perform a saphenofemoral junction reconstruction in patients presenting with greater saphenous vein reflux associated with low-grade (grades I-II) saphenofemoral junctional reflux. In this method, the size of the common femoral vein was adjusted to the desired diameter by a running linear suture technique after division of the greater saphenous vein.
Retrospective evaluation revealed that 73 limbs in 56 patients treated with this technique (group I). This group of patients was matched to another group of 65 patients (78 limbs) with similar characteristics and symptoms (group II) in whom the conventional complete ankle-to-groin stripping of greater saphenous vein was the treatment. The 2 groups were compared with respect to the incidence of complications, including recurrence of varicosities, ecchymosis, lymphocele, lymphorrhagia, wound infection, and paresthesia in the operated extremity. All patients also were evaluated by Doppler ultrasonography at 6 months, 12 months, and annually thereafter to determine the saphenofemoral junction reflux time (valve reflux time). The mean duration +/- SD of follow-up was 6.7 +/- 1.6 years (range, 2.1-10.8 years).
Recurrence of varicosity was noted in 14 patients, 3 in group I and 11 in group II (P = .02). There were no statistically significant differences between the 2 groups in terms of ecchymosis, hematoma, lymphocele, lymphorrhagia, wound infection, and paresthesia. At 6 months, a rapid decrease in valve reflux time was noted in group I (P = .0001). In addition, there was a significant improvement in valve reflux time at each subsequent Doppler examination in group I. Group II showed a decrease in valve reflux time, compared with the preoperative value (P = .068). During subsequent Doppler examinations, a decrease in valve reflux time also was noted in group II; this difference reached statistical significance only at 24 months (P = .04).
We believe that saphenofemoral junction reconstruction is a simple technique to perform and that addition of this method to the conventional stripping provides more durable results with a lesser incidence of recurrence. This method should be considered as a treatment modality in patients with greater saphenous vein reflux associated with low-grade (grades I-II) saphenofemoral junctional reflux.
对接受大隐静脉从踝部至腹股沟完全剥脱术的患者进行回顾性评估，以确定在剥脱过程中进行股隐静脉交界处重建的必要性。自1996年以来，除了传统的完全剥脱手术外，对于伴有轻度（I-II级）股隐静脉交界处反流的大隐静脉反流患者，我们常规进行股隐静脉交界处重建。在该方法中，大隐静脉离断后，通过连续线性缝合技术将股总静脉的大小调整至所需直径。
回顾性评估显示，56例患者的73条肢体接受了该技术治疗（I组）。将这组患者与另一组65例具有相似特征和症状的患者（78条肢体）（II组）进行匹配，II组采用传统的大隐静脉从踝部至腹股沟完全剥脱术治疗。比较两组并发症的发生率，包括静脉曲张复发、瘀斑、淋巴囊肿、淋巴漏、伤口感染以及手术肢体的感觉异常。所有患者在术后6个月、12个月及此后每年均接受多普勒超声检查，以确定股隐静脉交界处反流时间（瓣膜反流时间）。随访的平均时长±标准差为6.7±1.6年（范围为2.1 - 10.8年）。
14例患者出现静脉曲张复发，I组3例，II组11例（P = 0.02）。两组在瘀斑、血肿、淋巴囊肿、淋巴漏、伤口感染和感觉异常方面无统计学显著差异。术后6个月，I组瓣膜反流时间迅速缩短（P = 0.0001）。此外，在随后的每次多普勒检查中，I组瓣膜反流时间均有显著改善。II组瓣膜反流时间较术前有所缩短（P = 0.068）。在随后的多普勒检查中，II组瓣膜反流时间也有所缩短；这种差异仅在24个月时达到统计学显著水平（P = 0.04）。
我们认为股隐静脉交界处重建是一种操作简单的技术，在传统剥脱术基础上增加该方法可获得更持久的效果，且复发率更低。对于伴有轻度（I-II级）股隐静脉交界处反流的大隐静脉反流患者，应考虑将该方法作为一种治疗方式。
