选择性保留膝下大隐静脉主干预防静脉曲张手术中隐神经损伤的体会

The retention of the great saphenous vein below-knee decreases saphenous nerve injury duringvaricose veins surgery

目的探讨选择性保留膝下大隐静脉（greatsaphenousveins，GSV）主干在预防静脉曲张手术中隐神经损伤的作用。方法本研究为单中心前瞻性随机对照研究。2009年1月至2012年1月连续治疗280例大隐静脉曲张患者，随机分为2组，每组140例，观察组剥脱大隐静脉主干至膝下水平，对照组剥脱大隐静脉主干至内踝水平。2组均结合透光旋切（transilluminatedpoweredphlebectomy，TIPP）及泡沫硬化剂（foamsclerotherapy）治疗。主要观察指标为术后疼痛、隐神经缺失、症状改善情况及术后复发的发生率。结果术后随访1个月时，观察组有5．71％（8／140）出现神经系统症状，对照组有14．29％（20／140），（P=0．02）。术后随访12个月时，观察组有1．47％（2／136）主诉手术肢体感觉异常，对照组有7．14％（9／126），（P=0．02）。结论选择性保留膝下大隐静脉主干可减少隐神经损伤的发生。

Objective To evaluate selective retention of the great saphenous vein （GSV） below- knee in the prevention of saphenous nerve injury during varicose veins surgery. Methods From January 2009 to January 2012, 280 consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups. Patients in the experimental group underwent stripping restricted to the below knee level, patients in control group underwent GSV stripping to the ankle level. Patients in the two groups were treated with transilluminated powered phlebectomy, and foam selerotherapy. Primary end points were postoperative pain, saphenous nerve injury, quality of life and recurrence rate. Results After one month follow-up： 5.71% patients had symptoms of nervous system in the observation group, 14. 29% patients had symptoms of nervous system in the control group （P =0.02）. After 1 year follow-up, 1.47% patients had symptoms of nervous system in the observation group, 7.14% patients had symptoms of nervous system in the control group （ P = 0.02 ）. Conclusions Selective retention of great saphenous vein below-knee decreases saphenous nerve injury.