下肢静脉曲张术后复发的原因分析及个体化手术处理

目的探讨下肢静脉曲张术后复发原因及手术治疗的有效性。方法回顾性分析成都中医药大学附属医院血管外科收治的20例25条下肢静脉曲张术后复发患者的临床资料，所有患者同时进行彩色多普勒超声检查和顺行性下肢静脉造影，根据影像学特征差异采取个体化治疗方案。结果大隐静脉主干残留及大隐静脉剥脱不全4条，小隐静脉曲张4条，原发性深静脉瓣膜功能不全4条，交通支静脉功能不全8条，深静脉血栓形成后遗症2条、左髂静脉受压1条，布加氏综合症2条。采取个体化手术治疗后，以上病例均治愈或症状缓解。结论下肢静脉曲张术后复发的原因较为复杂，术前全面的影像学检查和选择正确的手术方式是避免术后静脉曲张复发的关键。根据不同复发原因要采取相应的个体化手术方案，可达到满意临床疗效。

Causes analysis and individual treatment of recurrent varicose veins after varicotomy in lower extremities

Objective To investigate the causes of recurrent varicose veins in lower extremities after varicotomy and the prevention and management of relapse. Methods 20 patients （25 lower extremities） with the recurrent varicose veins after varicotomy were analyzed. All patients underwent color Doppler Ultrasonography and ascending venography of deep vein in lower extremities for the function estimation of superficial and deep femoral veins as well as perforating veins. Treatment was based on the causes of recurrence. Results The relapse was attributable to remnant of the main trunk and partial branches of great saphenous vein （4 limbs）, Varicose small saphenous vein （4 limbs） ,primary deep ve- nous valves insufficiency（4 limbs）, simple insufficiency of perforating venous valves（8 limbs）, sequelae after deep venous thrombosis （2 limbs） and ipsilateral Cocket syndrome（1 limbs）,Budd-Chiari syndrome（2 limbs）. Some of the cases were cured and the others obtained partial remission after treatment. Conclusion Careful preoperative examination, intensive diagnosis,right surgical plan and skilled technique may reduce the relapse of this disease. It was effective to taken individual treatment for recurrent varicose veins.