下肢静脉曲张术后复发的原因分析(附46例报告)

Causes of the Recurrence of Varicose Veins after Varicotomy in Lower Extremity

目的分析下肢静脉曲张术后复发的原因。方法总结中山大学附属第二医院2002年6月至2004年8月收治的46例(52条患肢)下肢静脉曲张术后复发病人的临床资料,其中合并下肢静脉性溃疡20例(24条患肢)。所有病人均行深、浅静脉及交通静脉彩色多普勒超声检查和患肢顺行性深静脉造影。结果复发的原因有大隐静脉主干及其部分属支残存(11条患肢),合并交通静脉功能不全(35条患肢),合并深静脉瓣膜功能不全(20条患肢),出现小隐静脉曲张(10条患肢),深静脉血栓形成后遗症(5条患肢),同时存在3个静脉系统病变(15条患肢)。结论下肢静脉曲张术后复发的原因较为复杂,通常累及3个静脉系统。交通静脉功能不全是导致下肢静脉曲张术后复发的主要原因。术前全面的影像学检查和选择正确的手术方式是避免术后静脉曲张复发的关键。

Objective To analyze the causes of the recurrence of varicose veins after varicotomy in lower extremity. Methods Total 46 patients （52 lower extremities） with the recurrence of varicose veins after varicotomy were retrospectively analyzed. 20 patients （24 lower extremities） of them were accompanied by venous ulceration, All of the patients were accepted ascending phlebography and color Doppler uhrasonography of deep for superficial and perforating veins. Results The causes of the recurrence were ： remnant of the main trunk and partial branches of great saphenous vein （ 11 limbs ） , accompanying by the insufficiency of perforating veins （ 35 limbs ） , accompanying by the insufficiency of deep venous valves （20 limbs）, varicosis of small saphenous vein （10 limbs）, the sequelae after deep venous thrombosis （5 limbs）, simultaneous insufficiency of three venous systems （ 15 limbs）. Conclusion The causes of the recurrence of varicose veins after varicotomy in lower extremities are very complicated, usually involving three venous systems. The insufficiency of perforating veins is the main cause resulting in the recurrence of varicose veins after varieotomy in lower extremities. The pre-operative overall image examination and the choice of correct operation are the key for avoidance of the postoperative recurrence of varicose veins.