Mouton W G, Marklewitz M M, Friedli S, Zehnder T, Wagner H E, Heim D, De Maeseneer M G
Department of Surgery, Spital STS AG Thun, Switzerland.
Vasa. 2011 Jul;40(4):296-301. doi: 10.1024/0301-1526/a000118.
The effect of the type of surgery on neovascularisation in the groin is unknown. The aim of the present study was to compare three different surgical techniques used for recurrent saphenofemoral incompetence in view of their effect on neovascularisation in the groin at short- and long-term follow-up after surgery.
36 consecutive patients undergoing surgery for recurrent saphenofemoral incompetence were randomised. 12 patients underwent sharp dissection with knife or scissors and excision and ligation of scar tissue using absorbable suture material; 12 had dissection with electrocoagulation and 12 dissection with ultrasound (Ultracision Harmonic Scalpel). Clinical outcome was assessed using the venous clinical severity score and venous disability score, and the saphenofemoral junction was evaluated by means of duplex sonography three months and seven years after the operation respectively. If neovascularisation was present, the maximal diameter of new refluxing veins in the groin was measured.
There was no statistically significant difference between the three surgical techniques. Duplex ultrasound showed neovascularisation with an average maximal diameter (± standard error) of the newly formed refluxing vessel of respectively 2.00 (± 0.63) mm, 1.00 (± 0.45) mm and 0.50 (± 0.50) mm after three months and 4.29 (± 1.41) mm, 3.32 (± 0.90) mm and 3.00 (0.83) mm after seven years (no significant difference between groups). After seven years no reflux was detected in 8/36 patients, no varicose veins were found in 14/36 patients. The patients were less symptomatic than before our redo operation and no one needed reoperation within the seven years.
Dissection techniques in the groin did not influence the clinical and sonographic result at 3 months and at 7 years after redo surgery for recurrent varicose veins.
手术方式对腹股沟区新生血管形成的影响尚不清楚。本研究的目的是比较三种用于复发性大隐股静脉瓣膜功能不全的不同手术技术，观察其在术后短期和长期随访中对腹股沟区新生血管形成的影响。
36例连续接受复发性大隐股静脉瓣膜功能不全手术的患者被随机分组。12例患者采用手术刀或剪刀锐性分离，使用可吸收缝合材料切除并结扎瘢痕组织；12例采用电凝分离；12例采用超声刀（超声切割止血刀）分离。使用静脉临床严重程度评分和静脉功能不全评分评估临床结局，并分别在术后3个月和7年通过双功超声检查评估大隐股静脉汇合处。若存在新生血管形成，则测量腹股沟区新出现的反流静脉的最大直径。
三种手术技术之间无统计学显著差异。双功超声显示，术后3个月时新生血管形成，新形成的反流血管的平均最大直径（±标准误）分别为2.00（±0.63）mm、1.00（±0.45）mm和0.50（±0.50）mm；术后7年时分别为4.29（±1.41）mm、3.32（±0.90）mm和3.00（0.83）mm（组间无显著差异）。7年后，36例患者中有8例未检测到反流，14例未发现静脉曲张。患者的症状较再次手术前减轻，7年内无人需要再次手术。
腹股沟区的分离技术在复发性静脉曲张再次手术后3个月和7年时不影响临床和超声检查结果。
