Hiromoto Atsushi, Sakamoto Shun-Ichiro, Suzuki Kenji, Ishii Yosuke
Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan.
Department of Cardiovascular Surgery, Nippon Medical School Hospital, Tokyo, Japan.
Ann Vasc Dis. 2024 Dec 25;17(4):383-388. doi: 10.3400/avd.oa.24-00031. Epub 2024 Oct 15.
This study aimed to quantitatively evaluate peripheral nerve injury (PNI) after varicose vein (VV) surgery using endovenous laser ablation (EVLA). Overall, 25 cases were analyzed. All patients underwent EVLA of the great saphenous vein (GSV) with or without resection of the varix of the GSV tributaries in stab and avulsion fashion (microphlebectomy). For evaluation of PNI, the current perception threshold (CPT) was measured preoperatively at 1 week, 1 month, 3 months, and 6 months postoperatively. In each leg, CPT was measured at 6 points. PNI was defined as >40% elevation from preoperative data. A significant elevation in CPT was observed at 2 points (knee joint level [P = 0.01] and upper portion of the lower leg [P = 0.008]) 1 week postoperatively. CPT decreased after 1 month and recovered to the same level after 6 months. PNI occurred in 52% and 36% of patients at the knee joint level and upper portion of the lower leg, respectively. Microphlebectomy was indicated as a factor associated with PNI (P <0.01). Although VV surgery using EVLA is less invasive, the occurrence of transient PNI in the early postoperative period should be noted when concomitant microphlebectomy is performed.
本研究旨在定量评估采用腔内激光消融术（EVLA）治疗静脉曲张（VV）后周围神经损伤（PNI）情况。总共分析了25例病例。所有患者均接受了大隐静脉（GSV）的EVLA治疗，伴或不伴以刺伤和撕脱方式（微小静脉切除术）切除GSV属支的静脉曲张。为评估PNI，在术前以及术后1周、1个月、3个月和6个月测量电流感觉阈值（CPT）。在每条腿上，于6个点测量CPT。PNI定义为较术前数据升高>40%。术后1周时，在2个点（膝关节水平[P = 0.01]和小腿上部[P = 0.008]）观察到CPT显著升高。1个月后CPT下降，6个月后恢复到相同水平。膝关节水平和小腿上部PNI的发生率分别为52%和36%。微小静脉切除术被认为是与PNI相关的一个因素（P <0.01）。尽管采用EVLA的VV手术侵入性较小，但在进行微小静脉切除术时，应注意术后早期短暂性PNI的发生。
