Ramasastry S S, Dick G O, Futrell J W
Am Surg. 1987 May;53(5):274-7.
Sensory impairment in the saphenous nerve distribution after stripping of the long saphenous vein was studied in 14 patients undergoing bilateral vein stripping for symptomatic varicose veins. The vein was stripped upward in one leg and downward in the other to determine whether the direction in which the vein is stripped contributes to the incidence of such sensory impairment. Sensory evaluations at 12 weeks postoperatively revealed that ten of the 14 legs in the group that had the veins stripped upward demonstrated significant objective sensory deficits (P less than 0.001) compared with those that had the veins stripped downward (zero of 14). At 6 months the results were similar. To obtain anatomic correlation with the clinical findings, ten fresh cadaver dissections were carried out. In four of five legs in which the vein was stripped in an upward direction, the pretibial branch was avulsed off the main trunk and in two of five, the infrapatellar branch was avulsed. Such nerve avulsions did not occur on downward stripping. We recommend that the long saphenous vein be stripped downward to avoid sensory impairment in the saphenous nerve distribution.
对14例因症状性静脉曲张接受双侧静脉剥脱术的患者，研究了大隐静脉剥脱后隐神经分布区域的感觉障碍情况。在一条腿上向上剥脱静脉，在另一条腿上向下剥脱静脉，以确定静脉剥脱方向是否会导致这种感觉障碍的发生率。术后12周的感觉评估显示，与向下剥脱静脉的腿（14条腿中0条有明显客观感觉缺陷）相比，向上剥脱静脉的组中14条腿中有10条表现出明显的客观感觉缺陷（P小于0.001）。6个月时结果相似。为了获得与临床发现的解剖学相关性，进行了10次新鲜尸体解剖。在向上剥脱静脉的5条腿中的4条中，胫前分支从主干撕脱，在5条腿中的2条中，髌下分支撕脱。向下剥脱时未发生此类神经撕脱。我们建议向下剥脱大隐静脉，以避免隐神经分布区域的感觉障碍。
