Department of Surgery, Gloucestershire Royal Hospital, Gloucester, UK.
Eur J Vasc Endovasc Surg. 2011 Sep;42 Suppl 1:S57-60. doi: 10.1016/j.ejvs.2011.06.015.
To determine whether routine stripping of the long saphenous vein reduces recurrence after varicose vein surgery.
Randomised controlled trial. All operations done by a consultant vascular surgeon. Two year follow-up.
One hundred patients with primary long saphenous varicose veins (133 legs) were randomised. Two year follow-up in 81 patients (113 legs) with questionnaire, clinical examination and Duplex scanning.
Some 89% remained satisfied with the results of their surgery, though 35% had recurrent veins on clinical examination. Recurrence was reduced from 43 to 25% in patients who had their long saphenous vein stripped (p = 0.04, χ(2)). Neovascularisation (serpentine tributaries arising from the ligated saphenofemoral junction) was detected in 52% of limbs and was the commonest cause of recurrence. Most tributaries were less than 3 mm in diameter and only caused recurrence if the long saphenous vein or a major thigh vein was intact. Twelve patients had tributaries greater than 3 mm diameter and all had recurrent varicose veins.
Recurrence is common after varicose vein surgery and in this study was caused principally by neovascularisation at the ligated saphenofemoral junction. Clinical recurrence is reduced by routine stripping of the long saphenous vein.
确定静脉曲张手术后常规剥除大隐静脉是否会降低复发率。
随机对照试验。所有手术均由一名顾问血管外科医生完成。为期两年的随访。
100 例原发性大隐静脉曲张患者（133 条腿）进行了随机分组。81 例患者（113 条腿）进行了为期两年的随访，通过问卷调查、临床检查和双功能超声检查进行评估。
尽管 35%的患者在临床检查中发现静脉再次出现，但仍有 89%的患者对手术结果表示满意。在接受大隐静脉剥脱术的患者中，复发率从 43%降至 25%（p=0.04，卡方检验）。在 52%的肢体中发现了新生血管（从结扎的大隐静脉股静脉交界处出现的蛇形小分支），这是复发的最常见原因。大多数小分支直径小于 3 毫米，只有在大隐静脉或大腿主要静脉完整的情况下才会导致复发。12 例患者的小分支直径大于 3 毫米，所有这些患者均出现了静脉曲张复发。
静脉曲张手术后复发很常见，在本研究中，复发主要是由结扎的大隐静脉股静脉交界处的新生血管引起的。常规剥除大隐静脉可降低临床复发率。
