下肢静脉曲张术后复发181例分析

Analysis of the etiology and pathogenesis of recurrent varicose veins: a report of 181 cases

目的 探讨下肢静脉曲张术后的复发原因,提出复发性静脉曲张的预防与治疗策略.方法 回顾性分析中日友好医院2007年1月至2014年12月收治的复发性静脉曲张181例(共187条肢体)患者临床资料,包括该组患者初次手术情况、入院时CEAP评分、复发原因、治疗方案及治疗效果.结果 复发性静脉曲张最常见的初次手术是大隐静脉结扎+剥脱术、静脉腔内激光闭合术和大隐静脉结扎术,分别有97例(51.9％),31例(16.6％),22例(11.8％).最常见的复发原因是大隐静脉主干或属支残留62条(33.2％)、穿通静脉瓣膜功能不全57条(30.5％)和血管新生35条(18.7％).其他复发原因还包括小隐静脉瓣膜功能不全7条(3.7％),深静脉瓣膜功能不全23条(12.3％),深静脉血栓形成后综合征3条(1.6％),髂静脉受压综合征6条(3.2％).结论 复发性静脉曲张最常见的原因是初次手术不彻底、大隐静脉主干或属支残留或穿通支未处理完全和血管新生.初次手术彻底治疗反流及预防血管新生的发生有可能降低复发性静脉曲张的发生率.

Objective To investigate and analyze the etiology and pathogenesis of recurrent varicose veins on 187 limbs (181 patients).To propose prevention and treatment strategies for varicose veins.Methods The data of 187 limbs (181 patients) of recurrent veins admitted to our hospital between January 2007 and December 2014 were analyzed retrospectively.The items of type of primary operation,the CEAP scale when admitted and the etiology and pathogenesis of recurrent varicose veins were analyzed.Results In the 187 limbs,the most frequent primary operations were high ligation and stripping (97 limbs,51.9％),endovenous laser treatment (31 limbs,16.6％) and ligation only (22 limbs,11.8％),respectively.The etiologies of recurrent varicose veins were residual main great saphenous veins or tributaries (66 limbs,33.2％),incompetent perforator veins (57 limbs,30.5％),neovascularization (35 limbs,18.7％),incompetent small saphenous veins (7 limbs,3.7％),deep venous incompetent (23 limbs,12.3％),postthrombotic syndrome (3 limbs,1.6％) and iliac vein compression (6 limbs,3.2％).Conclusions Residual main great saphenous veins or tributaries,incompetent perforator veins and neovascularization are the main etiologies of postoperative recurrent varicose veins.Treatment of reflux completely when primary operation and prevention of neovascularization may decrease the incidence of recurrent varicose veins.