内镜深筋膜下穿通静脉离断联合腔内激光治疗下肢静脉曲张

目的: 探讨内镜深筋膜下穿通静脉离断术（subfascial endoscopic perforator surgery, SEPS）联合腔内激光治疗（endovenous laser treatment,EVLT）术治疗下肢静脉曲张的可行性。方法: 2016年8月至2017年10月,静脉顺行造影诊断下肢穿通静脉瓣膜功能不全患肢81条,选择40条患肢行SEPS术,联合EVLT术闭合浅表曲张静脉,保留健康大隐静脉作为研究组;41条患肢作为对照组,行传统大隐静脉高位结扎抽剥术。结果: 研究组曲张静脉团块消失,下肢静脉血淤滞得到缓解,色素沉着减轻,溃疡愈合,随访5~11个月无复发。研究组手术时间少于对照组（1.1 h比3.0 h）,切口数也少于对照组（2.1个比5.8个）,住院时间缩短（1.1 d比3.9 d）,下肢淤斑面积减少（5.2 cm³比20.3 cm³）,差异均有显著统计学意义（P<0.01）。结论: SEPS联合EVLT术适合个体化微创治疗下肢静脉曲张,创伤小、恢复快。

Subfascial endoscopic perforator surgery combined with endovenous laser ablation in treatment of lower extremity varicose veins

Objective To evaluate the feasibility of subfascial endoscopic perforator surgery (SEPS) combined with endovenous laser treatment (EVLT) in treatment of lower extremity varicose vein. Methods A total of 81 limbs with valve insufficiency of venous perforators diagnosed by ascending phlebography from August 2016 to October 2017 were selected including 40 limbs received SEPS combining with EVLT and preservation of greater saphenous vein as study group and 41 limbs received classic stripping of greater saphenous vein with high ligation as control group. Results Varicosities and tributaries of patients in 2 groups were all disappeared with skin pigmentation lightened and ulcer healed. The symptoms did not recur during the period of follow-up from 5 to 11 months. The operation time in study group was less than that in control group (1.1 h vs 3.0 h, P<0.01) and the incision number was less in study group than in control group (2.1 vs 5.8, P<0.01). Decrease in hospital stay (1.1 d vs 3.9 d, P<0.01) and ecchymosis area of lower extremities (5.2 cm² vs 20.3 cm², P<0.01) in study group was found when compared those in control group. The difference all had statistical significance. Conclusions SEPS combined with EVLT and preservation of greater saphenous vein in treatment of lower extremity varicose vein would be minimal invasive and recover quickly.