van den Bremer Jephta, Moll Frans L
Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands.
Ann Vasc Surg. 2010 Apr;24(3):426-32. doi: 10.1016/j.avsg.2009.07.035. Epub 2010 Feb 7.
Varicose veins are as old as Hippocrates. Varicose vein treatments come and go. Surgery for varicose vein disease is one of the commonest elective general surgical procedures. The history of varicose vein surgery has been traced. We note the first descriptions of varicose veins, and we particularly focus on the ligation of the saphenofemoral junction, stripping of the great saphenous veins, phlebectomy, and perforant vein surgery. We end with the rapid rise of minimally invasive procedures, such as foam sclerotherapy, radiofrequency ablation, and endovenous lasertherapy. Within 10 years, the advantages of minimal invasiveness for these procedures, combined with claims of equivalent short-term outcomes and even better long-term results, have already influenced our everyday practice. At present, the gold standard treatment of varicose veins still is surgical ligation and stripping of the insufficient vein. Concomitantly or sequentially with the treatment of truncal insufficiency, residual varicosities can be treated by phlebectomy. New minimally invasive techniques, however, have changed the clinical landscape for varicose vein surgery tremendously. The dramatic changes of the last decade are probably the precursors of the next generation.
静脉曲张与希波克拉底时代一样古老。静脉曲张的治疗方法不断更迭。静脉曲张疾病的手术是最常见的择期普通外科手术之一。静脉曲张手术的历史已被追溯。我们注意到静脉曲张的首次描述，尤其关注大隐静脉股静脉交界处结扎术、大隐静脉剥脱术、静脉切除术和穿通静脉手术。最后我们讲述了微创治疗方法的迅速兴起，如泡沫硬化疗法、射频消融术和腔内激光治疗术。在10年之内，这些手术微创性的优势，再加上声称的等效短期疗效以及甚至更好的长期效果，已经影响了我们的日常实践。目前，静脉曲张的金标准治疗方法仍然是对功能不全静脉进行手术结扎和剥脱。在治疗主干静脉功能不全的同时或之后，残留的静脉曲张可通过静脉切除术治疗。然而，新的微创技术极大地改变了静脉曲张手术的临床格局。过去十年的巨大变化可能是下一代技术的先驱。
