de Rijcke P A R, Hop W C J, Wittens C H A
Department of Vascular Surgery, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
J Vasc Surg. 2003 Oct;38(4):799-803. doi: 10.1016/s0741-5214(03)00430-0.
Endoscopic ligation of perforating veins (subfascial endoscopic perforating vein surgery [SEPS]) is valuable in treatment of venous ulcer on the medial aspect of the lower leg. Venous ulcerations on the lateral aspect of the lower leg are less common, but are of equal clinical importance.
Over 4 years we performed SEPS on the lateral aspect of the lower leg in 13 patients. Preoperative and postoperative duplex scanning of the perforating veins was performed in all patients.
Mean follow-up was 53 months (range, 33-81 months). Complete healing of venous ulcer was achieved in six patients within 6 months. Ulceration persisted in six patients, and ulcer recurred in three patients after 17, 29, and 60 months, respectively. Postoperative duplex scans showed persistent insufficient perforating veins in about 25% of patients.
There is a considerable difference between the results of SEPS on the medial side of the lower leg and the same procedure on the lateral side. SEPS on the lateral side of the lower leg, as performed in this small series, does not contribute to ulcer healing or recurrence. A considerable number of perforating veins are missed at surgery, resulting in persistent insufficient perforating veins postoperatively. The poor results of this study emphasize the need for adequate anatomic information to improve the surgical outcome.
内镜下结扎交通静脉（筋膜下内镜交通静脉手术[SEPS]）在治疗小腿内侧静脉性溃疡方面具有重要价值。小腿外侧的静脉性溃疡较少见，但具有同等的临床重要性。
在4年多的时间里，我们对13例小腿外侧患者进行了SEPS手术。所有患者均在术前和术后进行了交通静脉的双功扫描。
平均随访53个月（范围33 - 81个月）。6例患者在6个月内静脉溃疡完全愈合。6例患者溃疡持续存在，3例患者分别在17、29和60个月后溃疡复发。术后双功扫描显示约25%的患者存在持续功能不全的交通静脉。
小腿内侧SEPS的结果与外侧相同手术的结果存在显著差异。本小系列研究中所进行的小腿外侧SEPS对溃疡愈合或复发并无帮助。手术中遗漏了相当数量的交通静脉，导致术后持续存在功能不全的交通静脉。本研究的不良结果强调了获取充分解剖学信息以改善手术效果的必要性。
