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

Subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping

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.

Objective To evaluate the feasibility and efficacy of subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping.Methods Between July 2008 and July 2013,152 limbs of venous ulceration after great saphenous vein stripping were divided into two groups (conservative therapy and subfascial endoscopic perforator surgery therapy) and followed up at least for 2 years,respectively compared symptoms and signs improvement,ulcer healing time,ulcer healing and ulcer recurrence rate after healing for 6,12,24 months.Results No patient underwent the surgery occured pulmonary embolism or death,2 limbs appeared hematoma.Conservative and subfascial endoscopic perforator surgery group's symptoms and signs improvement rates were 81.9％ (59/72) and 86.3％ (69/80) (not significant,P =0.528),while the ulcer healing time,ulcer healing and ulcer recurrence rate respectively were 65.3％ (47/72) and 78.8％ (63/80),(73 ±15.7) d and (41 ± 12.6) d,34.0％ (16/47) and 14.3 ％ (9/63) (significantly different,P ＜ 0.05).According to the three time-points' (6,12,24 months) follow-up,the non-recurrence rate were 89.4％ (42/47) and 96.8％ (61/63),P=0.135;72.3％ (34/47) and 92.1％ (58/63),P=0.006;66.0％ (31/47) and 85.7％ (54/63),P =0.014.Conclusions Subfascial endoscopic perforator surgery is a reliable,safe and minimally invasive surgery,and has a long-term effect in treating varicose ulcer after great saphenous vein stripping.