内镜下大隐静脉交通支离断术术后并发症防治

Prevention of complications after subfascial endoscopic perforator surgery

目的探讨内镜下大隐静脉交通支离断术术后并发症的防治方法。方法回顾分析我院2002年1月至2005年12月收治下肢慢性静脉功能不全患者136例临床资料，共172条肢体均行内镜下大隐静脉交通支离断术（subfascial endoscopic perforator surgery，SEPS），155条肢体随访，随访率90．1％，随访时间1～36个月。结果SEPS术后出现筋膜下出血12条肢体（7．1％），皮下气肿18条肢体（10．5％），小腿前内侧及足踝区感觉麻木33条肢体（19．2％）。结论术前下肢静脉造影及结合Pratt试验定位交通支，术中膝关节上上止血带，术后应用弹力绷带能较好预防SEPS术后筋膜下出血及皮下气肿的发生。

Objective To study the preventions of postoperative complications of subfascial endoscopic perforator surgery. Methods 136 patients with 172 extremities who diagnosed as having chronic venous insufficiency were enrolled in our hospital from January 2002 to December 2005. All extremities were subjected to subfascial endoscopic perforator surgery. 155 extremities were followed up from one month to three years postoperatively. The followed - up rate was 90.196. Results 12 extremities （7.1% ） had hemorrhages under fascia and 33 extremities （19.2 % ） had anesthesia in anteriome dialis of leg and 18 extremities （10.5 % ） had cetaceous emphysema in all of patients who received subfasicial endoscopic perforator surgery. Conclusion Localization of perforator veins with phlebography in lower extremity and preoperative Pratt test,application of tourniquet upper articulation of knee in operation, postoperative application of pressure bandages are effective methods to prevent the complication of SEPS such as hemorrhage under fascia and coetaneous emphysema.