SEPS联合大隐静脉结扎剥脱术治疗中度下肢慢性静脉功能不全  

The Therapeutic Effect of Subfascial Endoscopic Perforator Surgery Combined with Great Saphenous Vein Ligation-stripping for C4 Chronic Venous Insufficiency

作　　者：周晓武[1] 黄蓉蓉[1] 王石林[1] 周庆[1] 刘叶[1] 马宁[1] 曹厚军[1] 

机构地区：[1]中国人民解放军空军总医院普通外科,北京100142

出　　处：《中国现代手术学杂志》2013年第2期101-103,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的评估腔镜筋膜下静脉交通支离断术(subfascial endoscopic perforator surgery,SEPS)联合大隐静脉高位结扎剥脱术治疗中度慢性下肢静脉功能不全(chronic venous insufficiency,CVI)的疗效。方法对34例患者共48条中度CVI患肢实施SEPS联合大隐静脉高位结扎剥脱手术(联合手术组),以同期单纯实施大隐静脉高位结扎剥脱手术的34例患者共49条中度CVI患肢(单纯手术组)作为对照,观察比较两组术后3月和12月的疗效。结果术后3月联合组和单纯组患肢症状改善和皮肤营养不良改善情况相似,组间比较无统计学差异(95.83%vs.93.88%,χ2=0.19,P>0.05;83.33%vs.79.59%,χ2=0.23,P>0.05),近期均无静脉曲张复发和溃疡形成。术后12月联合手术组和单纯手术组患肢症状改善者分别占97.92%和89.80%,组间比较差异无统计学意义(χ2=2.76,P>0.05);但皮肤营养不良改善者分别占87.50%和67.35%,组间差异有统计学意义(χ2=5.62,P<0.05);下肢静脉复发率分别为0%和10.20%,组间差异有统计学意义(P=0.03,P<0.05);下肢溃疡形成,两组分别为0%和4.08%,组间比较无统计学差异(P=0.26,P>0.05)。结论 SEPS联合大隐静脉高位结扎剥脱手术治疗中度CVI患者,较单纯大隐静脉高位结扎剥脱手术的远期效果更佳,能显著改善患者皮肤营养状况,预防静脉曲张的复发,更适合中度CVI患者。Objective To evaluate the therapeutic effect of subfascial endoscopic perforator surgery （SEPS） combined high ligation-stripping of great saphenous vein in the treatment of C4 chronic venous insuf- ficiency （CVI）. Methods A total of 48 limbs in 34 patients with C4 （according to the Clinical-Etiology- Anatomy-Pathophysiology classification） CVI were enrolled in this study as combined group. They were per- formed with SEPS procedure and great saphenous vein ligation-stfipping at the same time. As a control group, 49 limbs in 34 patients with C4 CVI were just performed with saphenous vein ligation-stripping. The clinical outcome of two groups was observed at 3 months and 12 months respectively. Results Overall 3-month limbs＂ symptom and skin improvement were similar and there was no statistic difference between the combined group and control group （95.83% vs. 93.88%, X2 =0.19, P〉0.05; 83.33% vs. 79.59%,x2 =0.23, P 〉 0.05 ）. No recurrence and ulcer occurred in both two groups at 3 months of following-up. Between the combined group and control group, the improvement rate of limb symptom were 97.92% and 89.80% re- spectively at one year without statistic difference （X2 = 2.76, P 〉 0.05 ） ; Improvement rates of skin nutrition were 87.50% and 67.35% respectively, and there was obvious difference （X2 =5.62,P 〈0.05） ; The local recurrence rate of affected limbs was 0% and 10.20% respectively and there was remarkable difference be- tween two groups （ P = 0. 03, P 〈 0. 05 ） ; New ulcer rates were 0% vs. 4. 08% without statisticdifference （P = 0.26, P 〉 0.05）. Conclusion The surgical intervention of SEPS combined with great saphe- nous vein ligation-stripping has better long-dated outcome in the treatment of CA CVI with advantages of signifi- cant improvement of skin nutrition and prevention of varicose recurrence.

关 键 词：静脉功能不全 下肢 腔镜筋膜下静脉交通支离断术 隐静脉 结扎术 静脉交通支 

分 类 号：R654.4[医药卫生—外科学] R543.6[医药卫生—临床医学]