Fligelstone L, Carolan G, Pugh N, Shandall A, Lane I
Cardiff Vascular Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
J Vasc Surg. 1993 Nov;18(5):836-40. doi: 10.1067/mva.1993.44789.
There is controversy in the surgical management of varicose veins between stripping of the long saphenous vein (LSV) and high ligation. Moreover, preservation of the LSV is desirable for future coronary or peripheral artery bypass. We have studied 75 limbs in 44 patients after high saphenous ligation with multiple stab phlebectomy.
Subjective assessment of the outcome of surgery was made with a linear analog scale, and objective cosmetic outcome was assessed by an independent observer (LF) who had not been involved in the surgical treatment of these patients with our modification from the criteria first described by Jakobsen. Patency, length, and diameter of the LSV was measured 6 to 14 months (mean 12 months) after operation with a duplex scanner and a color-flow scanner. Valvular incompetence in the LSV and perforators was also assessed.
Results show a good subjective and objective outcome in 95% and 97% of limbs, respectively. The LSVs were patent from ankle to groin in 68% and from ankle to knee in 82%, with a mean diameter of 4.0 +/- 0.1 mm (mean +/- SEM). There was no statistically significant difference in symptomatic outcome and presence of reflux in the LSV (X2 = 0.465; p = 0.4954; NS) or objective cosmetic outcome and the presence of reflux in the LSV (chi 2 = 2.916; p = 0.0877; NS).
It is concluded that high saphenofemoral ligation combined with multiple "stab avulsions" preserves an LSV with characteristics suggesting suitability for future use as a vascular prosthesis with good early symptomatic and cosmetic results.
在大隐静脉（LSV）剥脱术和高位结扎术治疗静脉曲张的手术管理方面存在争议。此外，保留大隐静脉对于未来的冠状动脉或外周动脉搭桥手术是可取的。我们对44例患者的75条肢体进行了高位大隐静脉结扎联合多处小切口静脉切除术的研究。
采用线性模拟量表对手术结果进行主观评估，由未参与这些患者手术治疗的独立观察者（LF）根据我们对雅各布森首次描述的标准进行修改后评估客观美容效果。术后6至14个月（平均12个月），使用双功扫描仪和彩色血流扫描仪测量大隐静脉的通畅情况、长度和直径。还评估了大隐静脉和穿支静脉的瓣膜功能不全情况。
结果显示，分别有95%和97%的肢体主观和客观结果良好。68%的大隐静脉从脚踝到腹股沟通畅，82%从脚踝到膝盖通畅，平均直径为4.0±0.1mm（平均±标准误）。大隐静脉有症状的结果和反流情况（X2 = 0.465；p = 0.4954；无统计学意义）或客观美容效果和大隐静脉反流情况（卡方 = 2.916；p = 0.0877；无统计学意义）之间没有统计学上的显著差异。
得出的结论是，高位大隐股静脉结扎联合多处“小切口撕脱术”可保留大隐静脉，其特征表明适合未来用作血管移植物，早期有良好的症状和美容效果。
