Noppeney T, Rewerk S, Winkler M, Nüllen H, Schmedt H C
Zentrum für Gefässmedizin, Obere Turnstrasse 8-10, 90429, Nürnberg, Deutschland.
Chirurg. 2007 Jul;78(7):620-9. doi: 10.1007/s00104-007-1366-9.
The classic varicose vein operation still represents the "gold standard" in the operative therapy of varicose veins. The results of this procedure in view of perioperative complications are very good, with the incidence of perioperative deep venous thrombosis varying between 0.05% and 0.1%. Recurrence rates between 6% and 60% are published. However, the true recurrence rate is unknown since an exact definition of recurrent varicosis is still lacking. In recurrent varices it is essential to distinguish between disease progression, including neorevascularisation, and technical errors. Endovascular procedures for elimination of the superficial venous system - radiofrequency obliteration and endovenous laser therapy - meanwhile have established themselves as alternative, minimally invasive procedures. The perioperative complication rate of endovenous procedures is very low and comparable to that of the classic operation. Good results, with occlusion rates of the treated vein around 87% to 93% up to 2 years postoperatively, have been published for both endovenous laser therapy and radiofrequency obliteration. For the latter, 5-year results were published, with occlusion of the treated vein in 87%. Results in the literature for radiofrequency are better documented than for endovenous laser treatment because there are now five prospective randomised trials for the former and most publications for endovenous laser treatment are single-center experiences. The advantage of endovenous procedures, especially radiofrequency obliteration, over the classic operation is the lower rate of perioperative pain and better quality of life. The spectrum of operative treatment methods of the superficial venous system has increased tremendously due to new technical developments. For the surgeon this implies the necessity of informing patients conscientiously about the pros and cons and available results of each procedure, and carefully weighing which methods are at the time best for the patient.
经典的静脉曲张手术仍是静脉曲张手术治疗的“金标准”。就围手术期并发症而言，该手术的效果非常好，围手术期深静脉血栓形成的发生率在0.05%至0.1%之间。已公布的复发率在6%至60%之间。然而，由于仍缺乏复发性静脉曲张的确切定义，真正的复发率尚不清楚。在复发性静脉曲张中，区分疾病进展（包括新生血管形成）和技术错误至关重要。消除浅静脉系统的血管腔内手术——射频消融和静脉腔内激光治疗——同时已成为替代的微创方法。静脉腔内手术的围手术期并发症发生率非常低，与经典手术相当。静脉腔内激光治疗和射频消融术后2年治疗静脉的闭塞率约为87%至93%，均已公布了良好的结果。对于后者，已公布了5年的结果，治疗静脉的闭塞率为87%。文献中关于射频的结果比静脉腔内激光治疗的记录更好，因为目前前者有五项前瞻性随机试验，而关于静脉腔内激光治疗的大多数出版物都是单中心经验。静脉腔内手术，尤其是射频消融，相对于经典手术的优势在于围手术期疼痛发生率较低，生活质量更好。由于新技术的发展，浅静脉系统手术治疗方法的范围有了极大的增加。对外科医生来说，这意味着必须认真告知患者每种手术的利弊和可用结果，并仔细权衡哪种方法在当时最适合患者。
