Herman J, Sekanina Z, Utikal P, Bachleda P, Duda M
Second Clinic of Surgery, Teaching Hospital of Palacky, University of Olomouc, Olomouc, Czech Republic.
Int Angiol. 2009 Dec;28(6):458-60.
The aim of the presented work was to assess the causes of injury to great nerves during varicose vein surgery and comment on the consequences.
This was a retrospective study of 2344 patients operated on for primary varicose veins between the years 1980 and 2005.
In three patients out of 2344 the peroneal nerve was injured. The three patients underwent neurosurgery. In the first patient transplantation of the sacral nerve was performed. In the second patient the nerve was released from ligatures, and in the third patient the nerve was first released from the cicatrice and the transposition of the tendon of the posterior tibial muscle followed. All three patients went through intensive rehabilitation. The first patient still wears peroneal splint, the limb is atrophic. In the second patient the function has been well restored and he is not disabled anymore. However, the restitution of the lower limb function is not sufficient for him to work as a teacher of physical education. The third patient still suffers from serious paresis of the peroneal nerve.
Even a frequent and relatively simple intervention such as varicose vein surgery may be accompanied by serious complications affecting patients for the rest of their lives. Serious motor nerve injuries are encountered only in operations in the popliteal fossa and the fibula head. Complications are more frequent when operations are performed by young general surgeons than when they are performed by an experienced surgeon or an expert in vascular surgery. The affected patients should be referred for neurosurgery; however, results are unpredictable. In spite of an intensive rehabilitation and possible plastic surgery the patients are permanently affected.
本研究旨在评估大隐静脉曲张手术中导致大神经损伤的原因并阐述其后果。
这是一项对1980年至2005年间因原发性大隐静脉曲张接受手术的2344例患者的回顾性研究。
2344例患者中有3例腓总神经受损。这3例患者均接受了神经外科手术。第一例患者进行了骶神经移植。第二例患者的神经从结扎处松解，第三例患者的神经先从瘢痕组织中松解，随后进行了胫后肌腱转位。所有3例患者均接受了强化康复治疗。第一例患者仍佩戴腓总神经夹板，肢体萎缩。第二例患者功能恢复良好，不再残疾。然而，下肢功能的恢复程度仍不足以使其胜任体育教师的工作。第三例患者仍患有严重的腓总神经麻痹。
即使是像大隐静脉曲张手术这样常见且相对简单的手术，也可能伴有严重并发症，影响患者的余生。严重的运动神经损伤仅见于腘窝和腓骨头处的手术。年轻普通外科医生进行手术时比经验丰富的外科医生或血管外科专家进行手术时并发症更常见。应将受影响的患者转诊至神经外科；然而，结果难以预测。尽管进行了强化康复治疗和可能的整形手术，患者仍会受到永久性影响。
