内镜下超声刀静脉交通支离断术治疗下肢静脉性溃疡

Subfascial Endoscopic Perforator Surgery with Ultrasonically Activated Scalpel for Treatment of Venous Ulcers of Lower Extremity

目的:探讨内镜下使用超声刀行静脉交通支离断术治疗下肢静脉性溃疡的临床应用及治疗价值。方法:90例下肢静脉功能不全伴静脉性溃疡患者,共有123条伴有静脉性溃疡的患肢,其中采用内镜下超声刀静脉交通支离断术治疗52例患者76条患肢(超声刀组,n=76),内镜下电凝钩静脉交通支离断术治疗38例47条患肢(电凝钩组,n=47),比较两组患肢平均离断交通支数、患肢平均手术时间(不包括浅静脉手术时间)、患肢平均术中出血量、术后并发症发生率和术后住院时间。结果:两组患肢平均离断交通支数差异没有统计学意义。在超声刀组,患肢手术平均时间(71.3±17.5)min,患肢平均出血量(30.3±5.4)ml,术后并发症发生率为(5.8±1.2)%,术后住院时间为(3.4±1.8)天,上述指标与电凝钩组比较,差异均有显著性(P<0.05)。结论:内镜下使用超声刀行使静脉交通支离断术更安全、更可靠、更精确,具有比普通电凝钩更好的使用价值和社会价值。

Objective： To explore the clinical and therapeutic value of treating venous ulcers of lower extremity by subfascial endoscopic perforator surgery （SEPS） with ultrasonically activated scalpel. Methods： Among the 123 affected limbs from 90 patients with chronic venous insufficiency and venous ulcers, 76 affected limbs from 52 patients were received SEPS with ultrasonically activated scalpel （ultrasonically activated scalpel group, n=76）, 47 affected limbs from 38 patients were received SEPS with electrocoagulation hook （electrocoagulation hook group, n=47）. Number of mutilated communicating branches, operating time, blood loss, postoperative complications and postoperative hospital stay in the two groups were compared. Results： There were no significant differences between the numbers of mutilated communicating branches in two groups. In the ultrasonically activated scalpel group, the average operation time was （71.3± 17.5） min, the average blood loss was （30.3± 5.4）ml, and postoperative complications rate was （5.8± 1.2）%, postoperative hospital stay was （3.4± 1.8）days. All the above-mentioned targets were significantly different, compared with the electrocoagulation hook group （P〈0.05）. Conclusions： The application of ultrasonically activated scalpel, made SEPS much safer, more reliable and more accurate than ordinary electrocoagulation hook. It has a better use of social values.