Winterborn R J, Earnshaw J J
Department of Surgery, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK.
Eur J Vasc Endovasc Surg. 2007 Sep;34(3):367-73. doi: 10.1016/j.ejvs.2007.03.019. Epub 2007 May 23.
The aim of this study was to assess the possible value of a polytetrafluoroethylene (PTFE) patch in the treatment of recurrent varicose veins.
Thirty-one patients (40 legs) with recurrent saphenofemoral junction incompetence were randomised to redo saphenofemoral ligation and great saphenous vein stripping with, or without the insertion of a PTFE patch over the ligated junction. Patients underwent assessment preoperatively, and at 6 weeks, 1 year and 2 years postoperatively with clinical examination, duplex imaging and completion of the Aberdeen Varicose Vein Symptom Severity Score (AVVSSS).
A total of 27 patients (32 legs) attended for assessment at 6 weeks, 25 patients (30 legs) at 1 year and 27 patients (32 legs) at 2 years. At 6 weeks, seven legs (22%) had an area of cutaneous numbness; all but one had resolved by 1 year. Four legs (13%) developed a groin infection, which required antibiotics, 2 had a groin haematoma and four had a seroma, all of which resolved spontaneously. The overall complication rate was 35% (11 legs), with no statistically significant difference between the groups. Four of 16 legs without a patch and five of 16 legs with a patch developed neovascularisation at the saphenofemoral junction on duplex imaging by two years postoperatively. Two cases of neovascularisation in the patch group and one in the no patch group directly resulted in clinical recurrence (p=1.0). There was an improvement in patients' AVVSSS two years postoperatively (p<0.03), that was similar in both groups.
In this study, insertion of a PTFE patch did not affect the rate of perioperative complications and it did not appear to contain neovascularisation.
本研究旨在评估聚四氟乙烯（PTFE）补片在复发性静脉曲张治疗中的潜在价值。
31例（40条腿）复发性大隐静脉股静脉交界处功能不全的患者被随机分为两组，一组在再次行大隐静脉股静脉结扎和大隐静脉剥脱术时，在结扎处上方插入PTFE补片，另一组不插入。患者在术前、术后6周、1年和2年接受评估，评估内容包括临床检查、双功超声成像以及完成阿伯丁静脉曲张症状严重程度评分（AVVSSS）。
共有27例患者（32条腿）在术后6周接受评估，25例患者（30条腿）在1年时接受评估，27例患者（32条腿）在2年时接受评估。术后6周时，7条腿（22%）出现皮肤麻木区域；除1条腿外，其余均在1年内恢复。4条腿（13%）发生腹股沟感染，需要使用抗生素治疗，2条腿出现腹股沟血肿，4条腿出现血清肿，所有这些均自行消退。总体并发症发生率为35%（11条腿），两组之间无统计学显著差异。术后两年，双功超声成像显示，16条未使用补片的腿中有4条、16条使用补片的腿中有5条在大隐静脉股静脉交界处出现新生血管形成。补片组有2例新生血管形成直接导致临床复发，未使用补片组有1例，差异无统计学意义（p = 1.0）。术后两年患者的AVVSSS有所改善（p < 0.03），两组情况相似。
在本研究中，插入PTFE补片不影响围手术期并发症发生率，且似乎无法抑制新生血管形成。
