腔镜深筋膜下交通静脉离断术治疗下肢静脉性溃疡  

Experience of subfascial endoscopic perforator surgery in treatment of lower extremity venous ulcers

作　　者：马瑞鹏[1] 戴向晨[1] 罗宇东[1] 章志翔[1] 

机构地区：[1]天津医科大学总医院普通外科,天津300052

出　　处：《中国普通外科杂志》2012年第12期1510-1514,共5页China Journal of General Surgery

摘　　要：目的：探讨腔镜深筋膜下交通静脉离断术（SEPS）治疗下肢静脉性溃疡（VLU）的临床效果。方法：回顾性分析3年半内收治的70例（76条患肢）下肢静脉功能不全患者的临床资料。按CEAP临床分类,其中C4级38例（41条患肢）,C5级18例（18条患肢）,C6级14例（17条患肢）。18例（18条患肢）C4级患者行大隐静脉高位结扎分段剥脱术（传统组）,其余患者采用SEPS联合大隐静脉高位结扎分段剥脱术（SEPS组）。分析患肢手术前后的CEAP临床评分及患肢溃疡愈合时间和复发情况。结果：SEPS组患者术后曲张静脉团消失,患肢酸胀及沉重感逐渐减轻,局部瘙痒及创面疼痛缓解;C5级患者溃疡愈合区色素沉着及硬化明显改善,皮炎消失;C6级患者足靴区活动性溃疡在术后10~60 d（平均47.3 d）愈合;术后患肢的CEAP临床评分均低于术前（均P〈0.05）;平均随访15个月,无复发患者。SEPS组C4级患者与传统组患者术后各项评分均无统计学差异（均P〉0.05）。结论：SEPS是治疗重度下肢静脉功能不全合并VLU的有效方法。Objective： To investigate the clinical efficacy of subfascial endoscopic perforator vein surgery （SEPS） in treatment of lower extremity venous ulcers （venous leg ulcers, VLU）. Methods： The clinical data of 70 patients （76 affected legs） with chronic venous insufficiency （CVI） of lower limb admitted within three and a half years were retrospectively analyzed. According to CEAP clinical classification, 38 cases （41 affected legs） were classified as stage C4, 18 cases （18 affected legs） as CS and 14 cases as C6, respectively. Of the patients, 18 C4 cases （18 affected legs） underwent high ligation and short segment stripping of the greater saphenous vein （traditional group）, and all of the other cases underwent SEPS procedure combined with high ligation and short segment stripping of the greater saphenous vein （SEPS group）. The CEAP clinical scores of the affected legs before and after operation, and ulcer healing time and recurrence of the affected legs were analyzed. Results： In the patients of SEPS group, the varicosities disappeared after surgery, dull ache and heavy sensation of the affected leg were gradually alleviated, and local itching and ulcer wound surface pain were relieved; the pigmentation and induration in the area of healed ulcerations were obviously improved, and dermatitis disappeared in C5 patients; the active ulcers in the gaiter area in C6 patients healed within 10-60 d （average of 47.3 d） after surgery; the postoperative CEAP clinical scores of the affected legs were all lower than those before surgery （all P〈0.05）, and no recurrence was seen during the follow-up period （average of 15 months）. No significant differences were noted in the clinical scores between the C4 patients who underwent SEPS and no SEPS （all P〉0.05）. Condusion： SEPS is an effective treatment method for severe low limb CVI with VLU.

关 键 词：静脉曲张溃疡 治疗 静脉功能不全 下肢 深筋膜下交通静脉离断术 腔镜 

分 类 号：R654.4[医药卫生—外科学]