内翻式大隐静脉剥脱术对交通支反流的影响

Influence of invaginated stripping of great saphenous vein on perforator reflux

目的:探讨内翻式大隐静脉剥脱术对反流交通支的影响。方法:选择2010年3月—2012年3月收治的合并有交通支反流的下肢静脉曲张患者36例(39条患肢)行内翻式大隐静脉剥脱术治疗,术后采用临床表现严重程度评分(VCSS)评估临床症状的改善情况,采用超声观察交通支反流的变化情况。结果:36例患者均获术后1年随访。术前VCSS为5.12±1.36,术后1年为1.25±1.48,两者间差异有统计学意义(P<0.05)。术前超声检查出反流交通支143条,位于大腿部的反流交通支34条,位于小腿部的反流交通支109条;术后1年超声复查共检查发现原反流交通支仍存在28条(19.6%),位于大腿部的反流交通支2条(5.9%),位于小腿部的反流交通支26条(23.9%)。结论:对合并交通支反流的静脉曲张患者仅施以浅静脉手术就可以达到改善症状及减少反流交通支的目的,浅静脉手术疗效不佳时再进行交通支手术。

Objective： To investigate the influence of invaginated stripping of great saphenous vein on perforator reflux.Methods： Thirty-six patients（39 affected legs） with varicose vein of lower limbs associated with perforator vein reflux admitted from March 2010 to March 2012 were selected to undergo invaginated stripping of great saphenous vein. After operation, the symptomatic improvement was evaluated by using venous clinic severity scoring（VCSS） and the condition of perforator vein reflux was observed by color duplex ultrasound.Results： Follow-up was obtained in all patients at one year after operation. The score of VCSS was 1.25±1.48 before operation, which was 5.12±1.36 one year after operation, and the difference achieved statistical significance（P〈0.05）. A total of 143 refluxing perforator veins was detected by duplex scan before operation, with 34 in the upper leg and 109 in the lower leg, and postoperative ultrasound examination demonstrated that 28（19.6%） previously refluxing perforator veins persisted, with 2（5.9%） in the upper leg and 26（23.9%） in the lower legs.Conclusion： For varicose veins with perforator reflux, superficial vein surgery alone can achieve the goal of relieving symptoms and reducing perforator reflux, while perforator vein surgery may be considered if superficial vein surgery is unsatisfactory.