Samson R H, Yunis J P, Showalter D P
Vascular & Surgical Associates, Sarasota, Florida, USA.
Am J Surg. 1998 Aug;176(2):168-71. doi: 10.1016/s0002-9610(98)00126-3.
Controversy still exists as to whether the thigh saphenous vein should be stripped concomitant with high ligation and phlebectomy.
A total of 218 procedures were retrospectively grouped into three groups: group 1, 10 limbs with visible, duplex scan-confirmed varicose veins of the thigh saphenous vein; group 2, 13 saphenous veins with varices that were not clinically evident; group 3, 195 limbs with incompetent saphenous veins without thigh saphenous varices.
Five limbs in group 1 were treated by high ligation, phlebectomy, and thigh saphenectomy. All did well. Five had high ligation and phlebectomy only. Two developed painful phlebitis, and two had residual varices in the saphenous vein. Group 2 and group 3 were treated by high ligation and phlebectomy. One group 2 limb developed saphenous phlebitis. Five limbs in group 3 developed recurrent veins that were removed in the office.
Thigh saphenectomy is only required when there are visible, duplex scan-confirmed varices of the thigh saphenous itself, or when the procedure is performed for severely symptomatic patients or those with advanced stasis changes.
对于在大隐静脉高位结扎及静脉切除术时是否应同时剥脱大腿部大隐静脉仍存在争议。
回顾性地将218例手术分为三组：第1组，10例肢体存在经双功超声扫描确认的大腿部大隐静脉可见性静脉曲张；第2组，13例存在无临床明显表现的大隐静脉曲张；第3组，195例肢体存在大隐静脉功能不全但无大腿部大隐静脉曲张。
第1组中5例肢体接受了高位结扎、静脉切除术及大腿部大隐静脉剥脱术。所有患者情况良好。5例仅接受了高位结扎及静脉切除术。2例发生疼痛性静脉炎，2例大隐静脉存在残留静脉曲张。第2组和第3组接受了高位结扎及静脉切除术。第2组中有1例肢体发生大隐静脉炎。第3组中有5例肢体出现复发性静脉，在门诊进行了处理。
仅在存在经双功超声扫描确认的大腿部大隐静脉自身可见性静脉曲张时，或对症状严重的患者或存在晚期瘀血改变的患者进行手术时，才需要进行大腿部大隐静脉剥脱术。
