下肢浅静脉曲张复发原因分析及再处理对策

Causes and optimal therapeutic strategy of recurrent varicose veins in lower limb

目的:探讨下肢静脉曲张复发的原因及再处理策略。方法:回顾性分析2009年1月至2012年6月收治的复发性下肢浅静脉曲张病人的临床资料。219例病人共252条肢体入组,男76例(94条肢体),女143例(158条肢体);平均年龄(54.3±7.3)岁。所有病人入院前均接受过下肢静脉曲张治疗,静脉曲张平均复发时间为(12.7±4.1)(6～57)个月。再次手术前多普勒超声或术中探查发现,大隐静脉残端过长19条肢体(7.5%),双大隐静脉或残留大隐静脉主干49条肢体(19.4%),交通支瓣膜功能不全189条肢体(75.0%),初次手术时遗留大隐静脉属支34条肢体(13.5%),新生血管形成65条肢体(25.8%),大隐静脉曲张术后新发小隐静脉曲张10条肢体(3.4%)。针对病因采取相应措施。结果:平均随访(16.3±11.5)(3～42)个月,治疗后3个月溃疡直径明显缩小,6个月时溃疡完全愈合;患肢酸胀、沉重感消失。6条深静脉血栓后遗症肢体溃疡再次复发,经保守治疗好转。结论:下肢静脉曲张治疗后复发多为数种原因综合所致,有技术及治疗方案失误、静脉疾病本身进展、新生血管形成,根据静脉曲张复发的原因作处理,取得满意的治疗效果。

Objective To explore the potential causes and the optimal treatments of recurrent varicose veins of lower limbs. Methods Data of patients admitted for recurrent varicose veins in lower limb between Jan 2009 and Jun 2012 were reviewed. Altogether 252 limbs in 219 patients were included. There were 76 male patients （94 limbs） and 143 female patients （158 limbs）. The average age was （54.3±7.3） years. The duration between recurrent varicose and the last operation was （12.7±4.1） months（from 6 to 57 months）. Ultrasound or DSA examination before re-treatment revealed long great saphenous vein stump in 19 limbs （7.5%）, double great saphenous vein or residual saphenous vein in 49 limbs （19.4%）, perforator vein valve insufficiency in 189 limbs （75%）, the residual branch of the great saphe-nous vein in 34 limbs （13.5%）, neovascularization in 65 limbs （25.8%）, and small saphenous vein varicose in 10 limbs （3.4%） after great saphenous varicose vein surgery. Treatment was based on the causes of recurrence. Results All the patients were followed. Three months after treatment, the diameter of ulcer reduced. Ulcer completely healed at 6 month after treatment. Limb swelling and a feeling of heaviness disappear. In 6 limbs with deep venous thrombosis, ulcer relapsed and cured by conservative treatment. Conclusions Factors in varicose vein recurrence include improper surgical procedure, unskilled performance and neovascularization. Treatment should be based on the related pathogenesis of the recurrence of varicose veins.