Sarin S, Shields D A, Farrah J, Scurr J H, Coleridge-Smith P D
Department of Surgery, University College and Middlesex School of Medicine, Middlesex Hospital, London.
J R Soc Med. 1993 Jan;86(1):21-3.
We have looked at the deterioration in the condition of the lower limbs in a group of 36 patients who were waiting for a median time of 20 months for varicose vein surgery, using clinical examination, colour Duplex scanning and photoplethysmograph (95% refilling times). We found a significant deterioration in this group of patients, with four limbs initially unaffected developing reflux on Duplex scanning, of which three had clinical varicose veins (all four were offered surgery), and of the initial 56 involved limbs, 10 further sources of reflux were found (18%), necessitating alteration of the initial planned surgical procedure. No patient developed deep venous insufficiency or ulceration while on the waiting list, although there was one new case of lipodermatosclerosis. However, had surgery been undertaken after the first assessment, 14 patients (25%) would potentially have required further surgery, although accepting this as justification for allowing patients to wait takes no account of patients suffering or quality of life while waiting for operation.
我们观察了一组36例等待大隐静脉曲张手术的患者下肢状况的恶化情况，这些患者等待手术的中位时间为20个月，采用了临床检查、彩色双功超声扫描和光电容积描记法（95%再充盈时间）。我们发现这组患者的病情有显著恶化，最初4条未受影响的肢体在双功超声扫描时出现反流，其中3条有临床可见的大隐静脉曲张（这4条肢体均接受了手术），在最初受累的56条肢体中，又发现了10处反流源（18%），这就需要改变最初计划的手术方案。在等待手术期间，没有患者出现深静脉功能不全或溃疡，尽管有1例新发脂膜炎性硬化症。然而，如果在首次评估后就进行手术，14例患者（25%）可能需要进一步手术，不过将此作为允许患者等待的理由并未考虑患者在等待手术期间所遭受的痛苦和生活质量。
