分析81例下肢静脉曲张术后复发原因

Analysis of postoperative recurrence of varicose veins of lower extremity in 81 cases

目的 研究下肢浅静脉曲张术后复发的原因及相应的预防和治疗方法.方法 回顾性分析扬州市第一人民医院血管外科2010年9月-2016年10月收治的81例术后复发性下肢静脉曲张患者,入选患者术前均行下肢静脉顺行造影检查.术后随访6 ～48个月,采用门诊与电话随访的方式,以症状、体征及下肢血管彩超检查为随访内容.结果 大隐静脉全段或属支残留19例,深静脉瓣膜功能不全31例,穿通静脉瓣膜功能不全25例,小隐静脉曲张主干残留者3例,髂静脉受压综合征10例,深静脉血栓形成后遗症5例,静脉畸形骨肥大综合征1例,部分患者合并有2个或2个以上复发原因.再次手术后所有患者下肢浅静脉曲张治愈率100％,且无深静脉血栓形成等严重并发症发生.随访中,12例术后出现不同程度的皮下瘀斑,口服药物观察,后期消退;5例局部皮下血肿,2例单纯注射器抽吸后加压包扎出现好转,3例行局部切口折除缝线,引流换药、延迟愈合;6例患者出现小腱足靴区皮肤麻木等感觉障碍,口服相关神经营养药物,术后1～6个月内好转.其余患者术后恢复良好.结论 多种原因均可导致下肢浅静脉曲张,下肢浅静脉曲张是不同疾病的一个共同临床表现,术前全面检查以明确病因,有助于降低下肢浅静脉曲张术后复发的概率.

Objective To discuss the cause of relapse after the first surgery of varicose veins of lower limb,and corresponding prevention and treatment methods.Methods The data of 81 cases of recurrence varicose veins of lower limb in Department of Vascular Surgery,Yanzhou First People's Hospital from September 2010 to October 2016 were analyzed retrospectively,all patients receded ascending phlebography for deep veins Postoperative follow-up of 6 to 48 months was followed by the combination of outpatient and telephone follow-up,with the symptoms,signs and blood vessels of the lower extremities as the follow-up.Results Remnant of the main trunk or tributaries of great saphenous vein in 19 cases,31 limbs of deep venous incompetent,incompetent perforator veins 25 limbs,the residual of small saphenous vein were 3 cases,crockett's syndrome 10 cases,sequelae of deep venous thrombosis belongs to the residual 5 limbs,Klippel-Trenaunay syndrome 1 limbs.There were some patients who suffered from 2 reasons or more than two reasons simultaneously.After surgery again,the cure vate was 100％ and no serious complications such as deep vein throm-bosis.During the follow-up,12 patients showed different degrees of subcutaneous stasis,oral drug observation,and later regression.Local subcutaneous hematoma was 5 cases,2 cases of pure syringe were treated with pressure after suction,3 routine local incision was removed to remove stitches,drainage change and delayed healing.Six patients showed the sensory impairment of skin numbness in the leg boot area,and oral related neurotrophic drugs improved within 1 to 6 months after surgery.The remaining patients recovered well after operation.Conclusions Various causes can lead to the varicose vein of lower limb,a varicose vein of lower limb is a common clinical symptoms of many different diseases.Preoperative comprehensive examination to clarify the cause,this will help to reduce the probability of recurrence of lower extremity varicose veins.