Lin Sin-Daw, Cheng Kai-Hung, Lin Tsai-Ming, Chang Kao-Ping, Lee Su-Shin, Sun I-Feng, Wang Wen-Her, Lai Chung-Sheng
Division of Plastic and Reconstructive Surgery, Department of Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan.
Ann Plast Surg. 2006 Mar;56(3):289-94. doi: 10.1097/01.sap.0000197641.18499.b9.
Two hundred sixty-two cases of primary varicose veins in which the lesions extended to the areas of the lower third of the leg and/or the ankle were treated with the assistance of endoscopic surgery. The conditions of varicose veins were classified by the reporting standards in venous disease. The number of cases in lesions of C2, C4, C5, and C6 were 60, 156, 31, and 15, respectively. They were also classified into 4 clinicoanatomic types according to varicositic changes in normal veins. The number of cases in types I, II, III, and IV were 57, 88, 42, and 75, respectively. The incidence of skin changes resulting from varicosity were 100%, 90.5%, 53%, and 50% in types I, II, III, and IV, respectively. The incidence of skin changes in this series was 77.6%. About one fourth of the cases having skin changes progressed to C5 and/or C6 lesions. Early and radical treatment of varicose veins could prevent the occurrence of skin changes and subsequently avoid the incidence of C5 and/or C6 lesions. The mean number of incisions in each limb was 2.9. With good illumination and magnified monitor view, the varicose veins and incompetent perforating veins were radically excised, but the normal veins were preserved. Forty-six cases of C5 and C6 lesions were followed up at least 1 year postoperatively. Four cases were lost from follow-up. In all cases except 1, there has been no recurrence. The conditions of skin changes improved subsequently. The recurrent rate of ulceration was 2.4%. In treatment of primary varicose veins with or without ulceration, surgery with assistance of endoscopic surgery achieved a low recurrence of ulcerations and minimal operative scarring.
262例原发性静脉曲张患者，其病变累及小腿下1/3和/或踝部区域，在内镜手术辅助下接受了治疗。静脉曲张情况根据静脉疾病报告标准进行分类。C2、C4、C5和C6病变的病例数分别为60、156、31和15例。它们还根据正常静脉的静脉曲张变化分为4种临床解剖类型。I、II、III和IV型的病例数分别为57、88、42和75例。I、II、III和IV型静脉曲张导致皮肤改变的发生率分别为100%、90.5%、53%和50%。本系列中皮肤改变的发生率为77.6%。约四分之一有皮肤改变的病例进展为C5和/或C6病变。早期彻底治疗静脉曲张可预防皮肤改变的发生，进而避免C5和/或C6病变的发生。每个肢体的平均切口数为2.9个。在良好的照明和放大的监视器视野下，彻底切除静脉曲张和功能不全的穿支静脉，但保留正常静脉。46例C5和C6病变患者术后至少随访1年。4例失访。除1例患者外，所有病例均未复发。皮肤改变情况随后有所改善。溃疡复发率为2.4%。在内镜手术辅助下治疗原发性静脉曲张，无论有无溃疡，手术均实现了溃疡低复发率和最小的手术瘢痕。
