Bianchi Christian, Ballard Jeffrey L, Abou-Zamzam Ahmed M, Teruya Theodore H
Division of Vascular Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
J Vasc Surg. 2003 Jul;38(1):67-71. doi: 10.1016/s0741-5214(03)00472-5.
This study was undertaken to determine the results of subfascial endoscopic perforator vein surgery (SEPS) combined with ablation of superficial venous reflux.
Clinical data were retrospectively analyzed for 74 consecutive limbs (65 patients) in which this combination treatment was performed at a university medical center. Preoperatively, 58 lower extremities had an open venous ulcer (CEAP clinical class 6 [C(6)]) and 16 had healed ulceration (C(5)). Preoperative and postoperative ulcer care remained constant. Main outcomes measured included perioperative complications, ulcer healing, and ulcer recurrence. Clinical severity and disability scores were tabulated before and after surgery. Mean patient follow-up was 44 months.
Greater saphenous vein (GSV) stripping and varicose vein excision accompanied SEPS in 57 limbs (77%), and SEPS was performed alone or with varicose vein excision in 17 limbs that had previously undergone GSV stripping. Postoperative complications occurred in 12 limbs (16%), all with C(6) disease (P =.04). Ulcer healing occurred in 91% (53 of 58) of limbs with C(6) disease at a mean of 2.9 months (range, 13 days-17 months). Multivariate analysis demonstrated that ulcer healing was negatively affected by previous limb trauma (P =.011). Ulceration recurred in 4 limbs (6%) at 7, 20, 21, and 30 months, respectively. This was associated with a history of limb trauma (P =.027) and preoperative ultrasound evidence of GSV reflux combined with deep venous obstruction (P(R,O); P =.043). Clinical severity and disability scores improved significantly after surgery (both, P <.0001).
Most venous ulcers treated with SEPS with ablation of superficial venous reflux heal rapidly and remain healed during medium-term follow-up. Ulcer healing is adversely affected by a history of severe limb trauma, and ulcer recurrence is similarly affected by a history of limb trauma in addition to superficial venous reflux combined with deep venous obstructive disease. Overall, there was marked improvement of postoperative clinical severity and disability scores compared with those obtained before surgery.
本研究旨在确定筋膜下内镜交通静脉离断术（SEPS）联合浅静脉反流消融术的治疗效果。
对某大学医学中心连续进行该联合治疗的74条肢体（65例患者）的临床资料进行回顾性分析。术前，58条下肢有开放性静脉溃疡（CEAP临床分级6级[C(6)]），16条下肢溃疡已愈合（C(5)）。术前和术后的溃疡护理保持不变。主要测量指标包括围手术期并发症、溃疡愈合情况和溃疡复发情况。手术前后记录临床严重程度和残疾评分。患者平均随访44个月。
57条肢体（77%）在进行SEPS的同时行大隐静脉（GSV）剥脱术和曲张静脉切除术，17条先前已行GSV剥脱术的肢体单独进行SEPS或联合曲张静脉切除术。12条肢体（16%）发生术后并发症，均为C(6)级病变（P = 0.04）。58条C(6)级病变肢体中，91%（53条）的溃疡平均在2.9个月（范围13天至17个月）愈合。多因素分析表明，既往肢体创伤对溃疡愈合有负面影响（P = 0.011）。4条肢体（6%）分别在术后7、20、21和30个月出现溃疡复发。这与肢体创伤史（P = 0.027）以及术前超声显示的GSV反流合并深静脉阻塞（P(R,O)；P = 0.043）有关。术后临床严重程度和残疾评分显著改善（均P < 0.0001）。
大多数接受SEPS联合浅静脉反流消融术治疗的静脉溃疡愈合迅速，且在中期随访期间保持愈合状态。严重肢体创伤史对溃疡愈合有不利影响，除浅静脉反流合并深静脉阻塞性疾病外，肢体创伤史同样影响溃疡复发。总体而言,与术前相比，术后临床严重程度和残疾评分有显著改善。
