腔镜深筋膜下交通静脉结扎术治疗重度慢性下肢静脉功能不全

目的：探讨腔镜深筋膜下交通静脉结扎术（SEPS）治疗重度慢性下肢静脉功能不全（CVI）的临床疗效和安全性。方法：对89例CVI患者的临床资料进行回顾性分析。42例行大隐静脉高位结扎＋抽剥术（A组）, 47例行大隐静脉高位结扎＋抽剥术＋腔镜深筋膜下交通静脉结扎术（B组）。结果：症状改善和分级提高的比较, 两组无统计学意义(P＞0.05);溃疡愈合率B组高于A组(P＜0.05)；B组愈合时间短于A组（P＜0.05）；溃疡复发率B组低于A组（P＜0.05）；除静脉曲张复发（P＜0.05）外, 两组并发症均差异无统计学意义(P＞0.05)。结论：腔镜深筋膜下交通静脉结扎术治疗CVI效果满意, 术后并发症少, 安全可行, 具有一定的临床应用价值。     

内镜筋膜下交通静脉结扎治疗慢性下肢静脉性溃疡的临床体会

目的:探讨内镜筋膜下交通静脉结扎术(subfascial endoscopic perforator surgery,SEPS)治疗慢性下肢静脉性溃疡的临床效果。方法:回顾分析78例,86条下肢慢性静脉性溃疡患者行内镜深筋膜下交通静脉离断+大隐静脉高位结扎并抽剥术的临床资料。结果:患者术后均恢复良好,浅静脉曲张消失,溃疡愈合,未发生明显并发症,随访1~3年,无皮肤溃疡及浅静脉曲张复发。结论:大隐静脉高位结扎剥脱术+SEPS治疗下肢静脉性溃疡有效,患者创伤小、康复快,效果好。     

腔镜深筋膜下交通静脉结扎术疗效分析

目的 探讨腔镜下深筋膜下交通静脉结扎术(SEPS)对较严重的慢性静脉功能不全患者治疗的效果.方法 回顾性分析2006年1月至2006年12月收治的61 例严重慢性静脉功能不全患者的临床资料.32 例行SEPS+大隐静脉高位结扎垣抽剥术(A 组);29 例单纯行大隐静脉高位结扎垣抽剥术(B 组).结果 患者均随访3耀4 个月,两组症状改善和分级提高的比较无显著差异(P>0.05).B 组静脉曲张复发6 例,A 组无复发,两组比较有显著性差异(P<0.05);其他相关并发症(血肿及切口感染)、术后住院日及溃疡愈合率的比较,两组均无显著差异(P>0.05).A 组溃疡愈合时间及溃疡复发例数分别为(20.3依3.9)天及0 例,而B 组为(39.0依5.6)天及3 例,两组比较有显著差异(P< 0.01).结论 腔镜下深筋膜下交通静脉结扎术初步治疗效果满意、术后并发症少,具有一定的临床应用价值.     

腔镜下筋膜腔内交通支离断术治疗原发性大隐静脉曲张并皮肤溃疡

目的：探讨腔镜下筋膜腔内交通支离断术治疗原发性大隐静脉曲张并皮肤溃疡的效果及优势。方法：对36例原发性大隐静脉曲张患者（52条患肢）实施腔镜下筋膜腔内交通支离断术和大隐静脉主干高位结扎及抽剥术治疗,观察溃疡的愈合、住院时间及复发情况。结果：术后住院时间5～14d（平均9.5d）。随访3～24个月,溃疡于术后7～58d（平均14.6d）内愈合,未见复发及新生溃疡。结论：腔镜下筋膜腔内交通支离断术和大隐静脉主干高位结扎及抽剥术安全有效,损伤小,并发症少。     

泡沫硬化剂注射联合TriVex系统治疗下肢静脉曲张的临床分析

目的探讨分析泡沫硬化剂注射联合TriVex系统治疗下肢静脉曲张的手术方法、技巧及疗效。方法纳入2014年10月至2016年4月在中山大学附属东华医院血管外科就诊的152例下肢静脉曲张患者,应用泡沫硬化剂注射联合TriVex系统进行治疗,评估治疗术后症状缓解,局部术区情况以及并发症发生率。结果对152例220条患肢采用大隐静脉主干高位结扎抽剥后泡沫硬化剂注射联合TriVex系统透光旋切术治疗静脉曲张患者,术后下肢明显的曲张畸形静脉消失,无一例患者出现复发,下肢酸胀、乏力等临床症状缓解,溃疡创面愈合。并发症主要是隐神经损伤、皮下硬结、血肿形成、软组织感染、深静脉血栓。结论大隐静脉高位结扎抽剥后泡沫硬化剂注射联合TriVex系统透光旋切术治疗下肢静脉曲张疗效显著,具有切口小、并发症少、复发率低等优点。     

内镜下静脉交通支离断术治疗下肢静脉溃疡

目的：探讨电视内镜下静脉交通支离断术的方法，优点及疗效。方法：在电视内镜下行深筋膜下交通支离断术治疗明显浅静脉曲张，交通支及深静脉瓣膜功能不全伴有静脉性溃疡，其中3例系术后复发性溃疡，行常规大隐静脉高位结扎，抽剥，小腿曲张浅静脉分段抽剥或结扎，同时行内镜下静脉交通支离断，对1例内踝部巨大溃疡者术后1周加做植皮。结果：术后浅静脉曲张消失，静脉性溃疡10天－30天，内愈合，无切口感染并发症，1例巨大溃疡植皮成功，创面术后18天愈合，结论：内镜下静脉交通支离断术治疗静脉性溃疡初步效果满意，术后并发症少。     

冷光源引导下泡沫硬化剂注射小腿曲张浅静脉在下肢静脉溃疡治疗中的应用探讨

目的探讨冷光源引导下泡沫硬化剂注射小腿曲张浅静脉联合腔镜深筋膜下交通支静脉离断术(SEPS)及大隐静脉高位结扎抽剥术治疗下肢交通静脉功能不全所致的静脉溃疡中的作用效果。 方法选取2012年6月至2013年5月就诊的42例(46条患肢)小腿交通静脉功能不全合并浅静脉曲张的静脉溃疡患者,行SEPS术及大隐静脉高位结扎抽剥术,并在SEPS术的冷光源引导下行小腿曲张静脉泡沫硬化剂注射术。 结果共注射263条曲张浅表静脉。随访期间所有患者静脉溃疡均愈合。9例患者的9条下肢(9/46,19.57%)在术后4周内出现局部疼痛,口服止疼药可缓解。22例患者的24条下肢(24/46,52.17%)共46条静脉(46/263,17.49%)在术后1 ~ 2周出现沿治疗曲张静脉行程的黄褐色色素沉着,于3 ~ 6个月内自行消失。3例患者3条下肢(3/46,6.52%)共11条静脉(11/263, 4.18%)在治疗后1周出现沿曲张静脉分布的红、热、痛和压痛,诊断为浅表性静脉炎,外用多磺酸黏多糖乳膏后缓解。经过注射的263条曲张静脉中,245条(245/263,93.16%)达到治疗成功标准,18条(18/263,6.84%)达到部分成功标准,无一条静脉未成功注射。 结论冷光源引导下的小腿曲张静脉泡沫硬化剂注射联合SEPS术及大隐静脉高位结扎抽剥术是良好的治疗交通静脉功能不全所致静脉溃疡的方法,其长期作用效果有待进一步观察。     

下肢慢性静脉性溃疡的治疗和护理

目的 探讨治疗下肢慢性静脉溃疡有效、简单的方法.方法 采用筋膜下交通静脉结扎术(SEPS)结扎交通支静脉和静脉旋切技术(TriVex)清除表浅曲张静脉,配合局部使用新型的保湿敷料处理创面治疗下肢静脉性溃疡.结果 36例共42条患肢经手术治疗患肢酸胀感消失,曲张的浅静脉消失,全部静脉性溃疡创面在7～32天内愈合.随访4～16个月,无溃疡复发.结论 运用SEPS和TriVex技术配合创面局部使用新型的保湿敷料治疗下肢慢性静脉性溃疡,并发症少,创面愈合快.     

腔镜深筋膜下穿通静脉离断术治疗大隐静脉抽剥术后静脉性溃疡

目的 评估腔镜深筋膜下穿通静脉离断术治疗下肢大隐静脉抽剥术后静脉性溃疡的可行性及疗效.方法 对扬州市第一人民医院血管外科在2008年7月-2013年7月收治的152条大隐静脉抽剥术后下肢静脉性溃疡肢体的临床数据进行回顾性分析,分为保守治疗组(72例)和腔镜深筋膜下穿通静脉离断术组(80例),分别比较下肢症状和体征改善率、溃疡愈合时间、溃疡愈合率及溃疡复发率情况;针对已愈合溃疡随访2年,分别比较6、12、24个月时间点溃疡的未复发率情况.结果 腔镜深筋膜下穿通静脉离断术组患者未出现肺栓塞、死亡等严重并发症,其中2条肢体术后血肿,5例患者诉有术区皮肤的麻木;保守治疗和腔镜深筋膜下穿通静脉离断术组下肢症状和体征改善率分别为81.9％ (59/72)和86.3％ (69/80),两者差异无统计学意义(P=0.528);溃疡愈合率分别为65.3％ (47/72)和78.8％ (63/80),愈合时间分别为(73±15.7)d和(41±12.6)d.随访2年显示,复发率分别为34.0％(16/47)和14.3％ (9/63),差异均有统计学意义(P＜0.05);愈合溃疡6个月未复发率分别为89.4％ (42/47)、96.8％ (61/63),P=0.135;12个月未复发率分别为72.3％(34/47)和92.1％(58/63),P=0.006;24个月未复发率分别为66.0％ (31/47)和85.7％(54/63),P=0.014.结论 腔镜深筋膜下穿通静脉离断术结扎穿通静脉确实可靠,创伤小,安全性好;同时对于治疗大隐静脉抽剥术后静脉性溃疡具有良好的近中期疗效,值得在临床进一步推广应用.     

腔镜深筋膜下交通支结扎+溃疡周围环缝术治疗慢性下肢静脉性溃疡23例

目的 探讨腔镜深筋膜下交通支结扎（SEPS）＋溃疡周围环缝术联合治疗慢性下肢静脉性溃疡的临床疗效。方法 2004年3月至2006年9月对23例慢性下肢静脉性溃疡患者实施SEPS＋溃疡周围环缝术（联合治疗组）。另有SEPS组（19例）和溃疡周围环缝组（30例）作对照。所有病例均行常规大隐静脉高位结扎＋剥脱术。结果 联合治疗组溃疡于术后12～60d愈合,平均25．7d;SEPS组于术后18～90d愈合,平均35．1d;溃疡周围环缝组于术后21～90d愈合,平均47．3d,各组间差异均有统计学意义（P〈0．05）。3组间复发率比较,差异无统计学意义（P〉0．05）。结论 SEPS＋溃疡周围环缝术能够有效地治疗慢性下肢静脉性溃疡,2个术式联合应用其溃疡愈合时间较单独应用缩短。     

腔镜深筋膜下交通静脉离断联合小腿曲张静脉直视透光旋切术治疗活动性下肢静脉溃疡的早期疗效研究

目的：比较单纯腔镜深筋膜下交通静脉离断术（SEPS）与SEPS联合小腿曲张静脉直视透光旋切术（Trivex术）治疗活动性下肢静脉溃疡的早期效果。方法选择2009年1月至2012年12月入院的下肢静脉溃疡患者156例,按住院号单、双将患者分为试验组（SEPS＋Trivex术）和对照组（SEPS术）。比较两组患者术后第1、3、6个月溃疡愈合、复发、下肢肿痛及局部皮肤麻木等并发症的发生率。结果术后1个月两组患者的溃疡愈合率差异无统计学意义,试验组术区肿痛及麻木感均显著高于对照组（26.3%vs 11.2%,23.8%vs 10.1%,P＜0.05）,无患者溃疡复发;术后3个月试验组患者的溃疡愈合率高于对照组（80.0%vs 66.3%,P＜0.05）,术区肿痛稍低于对照组（5.0%vs 5.6%）,差异无统计学意义,麻木高于对照组（12.5%vs 3.4%,P＜0.05）;术后6个月试验组患者的溃疡愈合率高于对照组（91.3%vs 79.8%,P＜0.05）,试验组及对照组术后6个月术区肿痛发生率分别为3.8%及2.4%,差异无统计学意义,术区麻木消失。术后第6个月试验组静脉溃疡复发率低于对照组（1.25%vs 7.87%,P＜0.05）。两组患者术中及随访期间均未出现死亡病例,未发生深静脉血栓形成等严重并发症。结论虽然SEPS＋Trivex术后短期（1~3个月）轻微并发症的发生率较高,但在术后早期（6个月内）静脉溃疡治愈率更高,复发率更低,因此更适合下肢静脉溃疡的治疗。     

Role of Subfascial Endoscopic Perforator Surgery (SEPS) in Management of Perforator Incompetence in Varicose Veins : A Prospective Randomised Study

The study was carried out to compare the efficacy of subfascial endoscopic perforator surgery (SEPS) and open subfascial ligation of perforators in varicose veins. This study was conducted on 100 patients of varicose veins from January 2006 to December 2010. Clinical scoring and color Doppler were performed in all the patients before surgery. Patients were divided into two groups: Group A and Group B alternately. Management of the perforators was done by subfascial endoscopic perforator surgery (SEPS) in Group A and by open subfascial ligation of perforators in Group B. Fifty patients were treated in each group. All the patients underwent ligation of incompetent saphenofemoral junction with stripping of long saphenous veins wherever the junction was incompetent with multiple ligation of superficial prominent veins. SEPS was done by two-port method without any tourniquet or balloon dissector. Total numbers of perforators ligated were 178 in Group A and 136 in Group B. Patients in both the groups got symptomatic relief of symptoms, but ulcer healing in 33 % patients in Group A was faster as compared to Group B. However, at 3 months of follow-up the ulcers healed in all the patients in both groups. Incidence of wound infection was higher in group B (16 %) as compared to group A (0 %). There were residual perforators in 8 % of patients on color Doppler at 3 months of follow-up in Group B while there was no residual incompetent perforator in Group A. Subfascial endoscopic perforator vein surgery is a safe and effective method for treating incompetent perforating veins. The number of perforators ligated in SEPS was more as compared to the open subfascial ligation group. Possibly some perforators may be missed on Doppler localization and missed ligation, which may be a cause of future recurrence in varicose veins. Early relief of symptoms in terms of ulcer healing was better in the SEPS group with less wound complication rate; however, all the ulcers healed in both the groups at 3 months of follow-up. Cosmetic results were equal in both the groups. Major advantage of SEPS was less incidence of wound complications and less incidence of residual incompetent perforators. Hence, SEPS should be added for the management of perforators along with conventional surgery in varicose veins.     

Is the nihilistic approach to surgical reduction of superficial and perforator vein incompetence for venous ulcer justified?

OBJECTIVE: Twenty-five years ago, the senior author showed a 55% postoperative ulcer recurrence rate after open perforator ligation. Those data contributed to a nihilistic attitude toward incompetent perforating veins. Conversely, since the introduction of subfascial endoscopic perforator surgery (SEPS), we have undertaken ablation of superficial and perforator reflux as initial treatment in patients with ulcers (C6) or healed ulcers (C5). This report outlines our long-term results. METHODS: Between December 1994 and November 1999, SEPS was performed on 51 limbs in 45 patients with C5/C6 disease. Sixteen limbs underwent SEPS alone, and 35 had additional surgery on the greater saphenous vein (GSV), the lesser saphenous vein, or the tributary varicies. Data were collected according to the reporting standards in venous disease. Preoperative duplex scan of deep, superficial, and perforating veins was performed. Data were analyzed with Kaplan-Meier method, Mantel-Cox log-rank test, or t test. RESULTS: Of the 51 limbs that underwent SEPS, the GSV was stripped in 28. Twenty-nine were C6, and 22 were C5. Etiology was primary (Ep) in 25 limbs and secondary (Es) in 26 limbs. All limbs had duplex scan evidence of perforator incompetence (Ap), and deep insufficiency (A(D)) was seen in 39 cases (76%). Reflux predominated (P(R)). The clinical follow-up period was 0 to 82 months (median, 38 months). Venous disability scores improved from 9.8 before surgery to 4.2 at last follow-up (P <.05). Kaplan-Meier analysis showed 74% healing at 6 months. The presence of an ulcer more than 2 cm in diameter, secondary etiology, and SEPS without concomitant GSV stripping were associated (P <.05) with delayed healing. Among patients in whom ulcers healed or who were seen with healed ulcers, the 5-year ulcer recurrence rate was 13%. Lesser saphenous vein reflux was the only factor that correlated with increased ulcer recurrence. Deep system reflux as measured with duplex scan valve closure times did not correlate with the rate of ulcer healing or recurrence. CONCLUSION: Nihilism has no place in the management of venous disease in the 21st century. An aggressive approach to superficial and perforating vein reflux in this cohort of patients with C5 and C6 disease resulted in rapid ulcer healing and low 5-year recurrence rates. Prior saphenous vein stripping, large ulcers, and secondary etiology were associated with delayed healing. A less aggressive posture toward lesser saphenous vein reflux contributed to a higher recurrence rate in this subgroup of patients. These risk factors are useful in counseling patients as to their expected postoperative course; however, no combination of factors should a priori preclude surgical intervention in this group of patients.     

腔内射频闭合术联合TriVex刨吸术治疗下肢静脉功能不全

目的 评价腔内射频闭合术联合TriVex刨吸术治疗下肢静脉功能不全的疗效.方法 150例下肢静脉功能不全患者(150条患肢)随机分为A、B两组,每组75例.A组行大隐静脉射频闭合术联合曲张浅静脉TriVex刨吸术,B组行大隐静脉高位结扎抽剥术联合曲张浅静脉TriVex刨吸术.比较两组的手术时间、术后首次下床时间、术后48 h的疼痛视觉模拟评分(VAPS)值、术后住院天数、皮下血肿和皮下硬结的发生情况;比较患者对手术的自身评价、手术前后美国静脉联盟CEAP分级、临床严重程度计分(VCSS)、慢性静脉功能不全问卷(CIVIQ)生活质量评分的变化.结果 两组手术时间差异不显著,A组术后疼痛轻、下床时间早、住院天数少、皮下血肿发生率低,但皮下硬结发生率高于B组;术后4周对手术的评价A组优于B组;A、B手术前后CEAP分级、VCSS、CIVIQ评分变化差别有统计学意义(P<0.05),两组间VCSS分差、CIVIQ评分差异无统计学意义(P>0.05).结论 利用射频闭合术联合TriVex刨吸术治疗下肢静脉功能不全有效,且微创、并发症少、更具人性化;CEAP临床分级、VCSS临床计分和CIVIQ生活质量评分可用于评价其疗效.     

内镜下深筋膜下交通支离断术治疗老年下肢慢性静脉性溃疡

目的 :探讨电视内镜下深筋膜下交通支静脉离断术治疗老年下肢慢性静脉性溃疡的可行性。方法 :大隐静脉曲张 6例 (10条肢体 ) ,同时存在浅静脉倒流、交通支静脉功能不全和静脉性溃疡 ,4条肢体深静脉功能不全。手术方法为高位结扎大隐静脉 ,分段抽剥 ,内镜下行深筋膜下交通支离断术 ,1例行股静脉戴戒术。结果 :术后肢体症状和浅静脉曲张消失 ,肢体溃疡或皮炎 3周内愈合。结论 :内镜下深筋膜下交通支结扎术具有微创、有效的特点 ,是治疗下肢静脉功能不全性溃疡的有效方法     

Subfascial endoscopic perforator vein surgery combined with saphenous vein ablation: results and critical analysis

OBJECTIVE: This study was undertaken to determine the results of subfascial endoscopic perforator vein surgery (SEPS) combined with ablation of superficial venous reflux. METHODS: Clinical data were retrospectively analyzed for 74 consecutive limbs (65 patients) in which this combination treatment was performed at a university medical center. Preoperatively, 58 lower extremities had an open venous ulcer (CEAP clinical class 6 [C(6)]) and 16 had healed ulceration (C(5)). Preoperative and postoperative ulcer care remained constant. Main outcomes measured included perioperative complications, ulcer healing, and ulcer recurrence. Clinical severity and disability scores were tabulated before and after surgery. Mean patient follow-up was 44 months. RESULTS: Greater saphenous vein (GSV) stripping and varicose vein excision accompanied SEPS in 57 limbs (77%), and SEPS was performed alone or with varicose vein excision in 17 limbs that had previously undergone GSV stripping. Postoperative complications occurred in 12 limbs (16%), all with C(6) disease (P =.04). Ulcer healing occurred in 91% (53 of 58) of limbs with C(6) disease at a mean of 2.9 months (range, 13 days-17 months). Multivariate analysis demonstrated that ulcer healing was negatively affected by previous limb trauma (P =.011). Ulceration recurred in 4 limbs (6%) at 7, 20, 21, and 30 months, respectively. This was associated with a history of limb trauma (P =.027) and preoperative ultrasound evidence of GSV reflux combined with deep venous obstruction (P(R,O); P =.043). Clinical severity and disability scores improved significantly after surgery (both, P <.0001). CONCLUSIONS: Most venous ulcers treated with SEPS with ablation of superficial venous reflux heal rapidly and remain healed during medium-term follow-up. Ulcer healing is adversely affected by a history of severe limb trauma, and ulcer recurrence is similarly affected by a history of limb trauma in addition to superficial venous reflux combined with deep venous obstructive disease. Overall, there was marked improvement of postoperative clinical severity and disability scores compared with those obtained before surgery.     

激光闭合穿通支静脉治疗下肢静脉溃疡

目的 探讨激光闭合穿通支静脉在下肢静脉性溃疡治疗中的作用。方法 以2014年1月至2015年12月收治的28例下肢静脉溃疡（28条肢体）。所有病人均行CT静脉成像定位溃疡处穿通支静脉。14例行大（小）隐静脉高位结扎+穿通支静脉激光闭合术（激光组）,另14例行大（小）隐静脉高位结扎+穿通支静脉结扎术（对照组）。术后均以弹力袜加压并定期处理溃疡创面,随访2年。结果 两组病人一般情况无统计学差异。术前溃疡病程和溃疡面积均无统计学差异。激光组术后1周溃疡面积缩小值明显大于常规组（P<0.05）,1个月和2个月的溃疡面积缩小值无差异。对照组有6例发生切口愈合不良,高达42.9%,而激光组仅1例出现局部灼伤。两组间有明显统计学差异（P<0.01）。2个月内溃疡愈合的比例在两组间无差异,均为12例（85.7%）。两组1年内溃疡复发率亦无统计学差异（P>0.05）,1~2年内均无复发。结论 在大（小）隐静脉结扎的基础上,激光闭合穿通支静脉可有效促进溃疡愈合。     

内镜筋膜下超声刀离断交通支静脉治疗下肢静脉性溃疡25例分析

目的:探讨内镜筋膜下超声刀离断交通支静脉治疗下肢静脉性溃疡的安全性、可行性及临床疗效。方法:2002年6月至2009年3月用内镜筋膜下超声刀离断交通支静脉治疗21例共25条下肢静脉性溃疡,观察术前、术后下肢静脉功能改变及临床症状改善情况。结果:下肢活动性溃疡均愈合,平均愈合时间31d;切口均一期愈合;静脉曲张消失,皮肤营养障碍改善;随访4个月~7年无复发。结论:内镜筋膜下超声刀离断交通支静脉治疗下肢静脉性溃疡微创、安全、有效。