腔镜在下肢静脉性溃疡治疗中的应用

Application of Endoscope in Treatment for Venous Ulcer in Lower Limb

目的探讨腔镜在下肢慢性静脉功能不全(CVI)并发静脉性溃疡中的临床治疗经验与疗效。方法回顾性分析2004年5月至2011年4月期间我院应用腔镜治疗78例(88条患肢)下肢CVI并发静脉性溃疡患者的临床资料,患者均行大隐静脉高位结扎+腔内激光治疗(EVLT)+腔镜深筋膜下交通静脉离断术(SEPS)。结果所有患者手术顺利。SEPS手术时间15～30min,平均20min;术中出血量1～5ml,平均2ml;术后住院时间2～8d,平均5d。术后肢体酸胀感和曲张浅静脉消失,色素沉着区缩小。术后筋膜下血肿3例,皮下气肿2例,小腿胫前区及足靴区麻木感3例。所有患者4～6周溃疡愈合,随访0.5～5年,平均3.5年,仅1例复发,是由于足靴区交通静脉残留。结论 SEPS是治疗CVI并发静脉性溃疡的首选方法,具有创伤小、出血少、手术时间短、恢复快、并发症少、疗效显著等特点。

Objective To evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. Methods Seventy-eight patients（88 limbs） suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively.All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery（SEPS）. Results Postoperative complications included 3 cases of subfascial haematoma;2 cases of pneumohypoderma;3 cases of numbness in anterior tibial and ankle areas.All the ulcers healed between 4 to 6 weeks.Follow up period was between 6 months to 5 years.There was only one recurrence due to residual varicose from ankle area.The mean operation time was 20 min（15-30 min） in SEPS,the average blood loss was 2 ml（1-5 ml）,and the mean duration of postoperative hospitalization was 5 d（2-8 d）. Conclusions SEPS is a first treatment choice for CVI with venous ulcer.It has less invasiveness,lower chances for bleeding,shorter operation time,quicker recovery,and fewer complications.