下肢静脉曲张术后复发原因和再手术探讨

Causes of recurrence and reoperative strategy of lower extremities varicose veins

目的探讨下肢静脉曲张术后复发的原因及治疗策略。方法对本院2005年7月～2011年6月收治24例(31条患肢)下肢静脉曲张术后复发患者的临床资料进行回顾性分析。结果本组复发的主要原因有大隐静脉残留18条患肢,小隐静脉曲张未处理5条患肢;激光闭合术后曲张静脉再通4条患肢;交通支静脉功能不全6条患肢;深静脉血栓形成后综合征(PTS)4条患肢;血管再生与深静脉交通1条患肢。21例患者(28条患肢)接受再手术治疗,25条反流性静脉曲张患肢外观曲张静脉消失,1例随访时死亡,死时患肢无复发。3例PTS患者治疗后,2例溃疡愈合,1例仍反复溃疡。结论再手术前常规的影像学检查以此选择正确的手术方案是手术成功的关键。

Objective To explore the causes of recurrence and reoperative strategy of lower extremities varicose veins after varicotomy. Methods The clinical data of 24 patients (31 limbs) admitted in our hospital for lower extremities varicose veins recurrence after previous operation between July 2005 and June 2011 were analyzed retrospectively. Results The main reasons for the recurrence included residual saphenous vein in 18 limbs, untreated small saphenous vein in 5 limbs, recanalization of varicose veins in 4 limbs treated by laser, insufficiency of perforating venous in 6 limbs, post-thrombosis syndrome (PTS) in 4 limbs and neovascular connecting with deep veins in 1 limb. Twenty-one patients (28 limbs) underwent reoperation, and reflux varicose veins disappeared in 25 limbs postoperatively. One case died during the follow-up period without recurrence. Among 3 PTS cases, ulcers healed in 2 cases and unhealed in 1 case. Conclusions The routine imaging examination before surgery is the key to choose optimal reoperative strategy.