Oesch A
Ther Umsch. 1991 Oct;48(10):692-6.
The introduction of the stab-incision--phlebectomy (Muller's technique)--has opened a large field for ambulatory surgery. This is specially true when phlebectomy is combined with a saphena-femoral or saphena-popliteal ligature. In a series of 1825 operations including 1592 incompetent saphenous veins 1216 (67%) were performed under local anesthesia. Radical surgery of incompetent short saphenous veins as well as of minor forms of varicose long saphenous veins is feasible in local anesthesia. Regional or general anesthesia (609 operations) are still recommended for stripping procedures in advanced long saphenous varices. In most cases phlebectomy of varices (553) provides a better cosmetic result than sclerotherapy, the latter being the treatment of choice for small veins and telangiectasias. Ambulatory surgery and sclerotherapy are cost-effective and low-risk treatments. No deep vent thrombosis or pulmonary embolism was observed in this group, whereas 1 DVT and 2 PE occurred in the 609 operations performed under general anesthesia.
小切口静脉切除术(穆勒技术)的引入为门诊手术开辟了广阔领域。当静脉切除术与大隐静脉-股静脉或大隐静脉-腘静脉结扎术相结合时尤其如此。在包括1592条功能不全的大隐静脉在内的1825例手术中,1216例(67%)在局部麻醉下进行。在局部麻醉下,对功能不全的小隐静脉以及轻度静脉曲张的大隐静脉进行根治性手术是可行的。对于晚期大隐静脉曲张的剥脱手术,仍建议采用区域麻醉或全身麻醉(609例手术)。在大多数情况下,静脉曲张切除术(553例)比硬化疗法具有更好的美容效果,硬化疗法是小静脉和毛细血管扩张的首选治疗方法。门诊手术和硬化疗法是具有成本效益且低风险的治疗方法。该组未观察到深静脉血栓形成或肺栓塞,而在609例全身麻醉下进行的手术中发生了1例深静脉血栓形成和2例肺栓塞。