内镜筋膜下交通静脉离断术联合腔内激光治疗下肢重度慢性静脉功能不全30例临床分析

Subfascial endoscopic perforator surgery combined with endovenous laser treatment in managing severe chronic incompetent vein of lower extremities(a report of 30 cases)

目的总结下肢重度慢性静脉功能不全患者行内镜筋膜下交通静脉离断术(SEPS)联合腔内激光治疗的临床资料和治疗效果。方法所有患者均行顺行静脉造影明确诊断,超声检查确定无深静脉、小隐静脉瓣膜功能不全,均采用SEPS联合腔内激光进行治疗,术后观察各种临床症状的缓解情况及溃疡愈合时间。结果联合手术成功率100%,手术后10d患者临床症状明显缓解,症状完全消失者占86.3%,无术后并发症发生;15例足靴处溃疡手术后均愈合,时间为8～48d,平均18d。住院时间7～28d,随访3～18个月,疗效满意。结论SEPS联合腔内激光是治疗下肢重度慢性静脉功能不全的一种安全、有效、微创的方法,能有效避免常规足靴区手术后并发症的发生,创伤小,术后恢复快。

[Objective] To analyze the therapeutic effects of subfascial endoscopic perforator surgery （SEPS） combined with endovenous laser treatment （EVLT） for severe Chronic venous insufficiency. [Methods] The diagnosis was confirmed by ascending venography in 30 cases. Ultrasonic scanning was used to exclude incompetent small saphenous vein and deep vein. All the patients received SEPS and EVLT, and the relief of clinical symptoms and healing time of ulceration were observed. [Results] All of the operations succeeded and clinical symptoms relieved significantly or completely in 86.3% of the cases 10 days after operation. No complication occured. All of the 15 patients with ulceration healed and the healing time varied from 8 to 48 days with a mean of 18 days. The hospital stay varied from 7 to 28 days and the duration of follow-up varied from 3 to 18 months. The therapeutic effects were encouraging. [Conclusion] SEPS combined with EVLT is a safe, effective and minimally-invasive method in managing severe chronic venous insufficiency of lower extremities. It helps to avoid postoperative complications and patients can recover quickly for its minimal invasion.