Jones L, Braithwaite B D, Selwyn D, Cooke S, Earnshaw J J
Department of Surgery, Gloucestershire Royal Hospital, Gloucester, U.K.
Eur J Vasc Endovasc Surg. 1996 Nov;12(4):442-5. doi: 10.1016/s1078-5884(96)80011-6.
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, chi 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.
确定大隐静脉常规剥脱术是否能降低静脉曲张手术后的复发率。
随机对照试验。所有手术均由血管外科顾问医生完成。随访两年。
100例原发性大隐静脉曲张患者（133条腿）被随机分组。对81例患者（113条腿）进行了两年随访，采用问卷调查、临床检查和双功超声扫描。
约89%的患者对手术结果仍感满意，不过临床检查发现35%的患者出现了静脉复发。大隐静脉被剥脱的患者复发率从43%降至25%（p = 0.04，卡方检验）。52%的肢体检测到新生血管形成（从结扎的隐股静脉交界处发出的蜿蜒分支），这是复发的最常见原因。大多数分支直径小于3毫米，只有在大隐静脉或大腿主要静脉完整时才会导致复发。12例患者的分支直径大于3毫米，所有这些患者均出现了复发性静脉曲张。
静脉曲张手术后复发很常见，在本研究中主要是由结扎的隐股静脉交界处的新生血管形成所致。大隐静脉常规剥脱术可降低临床复发率。
