摘要
目的探讨原发性大隐静脉(GSV)曲张术中钩区处理技巧和1年疗效。方法南方医科大学南方医院近4年来624例(774条肢体)GSV曲张手术,其中265例(325条肢体)行钩区GSV骨骼化分离结扎,另有359例(449条肢体)常规高位GSV主干结扎,两组进而根据CEAP分期予以GSV主干的传统抽剥或激光闭合、小腿属支Muller术、交通支离断术以及溃疡的处理。结果研究组20例GSV属支于不同组织层次经卵圆窝汇入GSV或直接汇入股静脉,对照组14例把股内侧静脉或股外侧静脉误认为GSV。两组患者单肢手术时间无统计学差异(t=0.68,P≥0.05),研究组出血量小于对照组(t=1.75,P<0.05),研究组腹股沟区域出血发生率小于对照组(7/325 vs 15/449,V=2.12,P<0.05)。研究组术后1年VCSS和对照组存在统计学差异(2.1±0.5 vs 4.6±0.9,t=1.96,P<0.05),研究组术后1年内曲张静脉残留和复发率和对照组存在统计学差异(3/325 vs 13/449,V=1.25,P<0.05)。结论骨骼化分离钩区GSV主干、分支和汇入异常的浅静脉,可降低术后逆向血流引起的下肢静脉曲张残留和复发。
Objective To investigate the surgical technique of skeletonizafion of the great saphenous vein （GSV） at the saphenofemoral junction （SFJ） in surgical intervention of primary varicosity and evaluate the outcomes one year after the operation. Methods A total of 624 cases （774 limbs） of primary varicosity of the GSV were prospectively divided into skeletonization group （265 cases, 325 limbs） and control group （359 cases, 449 limbs）. In the skeletonizafion group, skeletonization of the GSV at the SFJ, its branches and other aberranfly joined superficial veins was performed, and in the control group, routine high ligafion of the GSV was performed, after which laser-ablation of the GSV, GSV stripping, Muller＇s operation, mutilation of the perforators and ulcer-related operations were performed in both groups. Results Twenty cases in the skeletonization group were found to have superficial veins directly joining into the femoral vein or into the GSV in different tissue layers. In 14 cases in the control group, the superficial veins of the interal femoris or lateral femoris were mistaken for the GSV. No difference was found in the operating time between the two groups （t=-0.68, P〉0.05）, but the skeletonizafion group had a significantly less bleeding volume （t=-1.75, P〈0.05）. Statistical differences were. found between the two groups in intraoperafive bleeding rate in the inguinal regions, venous clinical severity scores （2.1±0.5 vs 4.6±0.9, t=1.96, P〈 0.05）, and residual varicosity and recurrences （3/325 vs 13/449, V=1.25, P〈0.05） at the one year follow-up. Conclusion Skeletonization of the GSV and its branches and other aberranfly joined superficial veins at the SFJ can decrease the postoperative residual varicosity and recurrence due to blood reflux.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2012年第12期1800-1803,共4页
Journal of Southern Medical University
基金
2007年度中华医学教育课题(07JF19-10)
2010年度中华医学教育课题(20101809)
关键词
钩区
大隐静脉
静脉曲张
卵圆窝
saphenofemoral junction
great saphenous vein
varicose veins surgery
fossa ovalis
