Vascular Surgery Unit, Skaraborg Hospital/Kärnsjukhuset, Skövde, Sweden.
Br J Surg. 2011 Apr;98(4):495-500. doi: 10.1002/bjs.7370. Epub 2010 Dec 24.
The aim was to clarify the role of incompetent perforators (IPs) in venous leg ulcers. This short-term report focused on safety, patient satisfaction and the fate of IPs after subfascial endoscopic perforator surgery (SEPS), or saphenous surgery alone.
Patients aged 30-78 years with an open or recently healed venous ulcer, and with an incompetent saphenous vein and IPs, were allocated randomly to saphenous surgery alone, or in combination with SEPS. A control duplex scan was performed 6-9 months after surgery, and clinical follow-up was scheduled after 1 week, 3 and 12 months. A standard questionnaire was completed at each clinical visit.
Seventy-five patients were enrolled; 37 had SEPS and 38 had saphenous surgery alone. SEPS prolonged the operation by a median of 15 min (P = 0.003). Duplex imaging revealed significantly more remaining IPs in the no-SEPS group (P < 0.001). Compared with the preoperative scan, significantly more legs were free from IPs in the SEPS group compared with the no-SEPS group (21 of 36 versus 7 of 37 respectively; P < 0.001). There were no other major outcome differences between the groups.
There was no short-term clinical benefit from adding SEPS to saphenous surgery in patients with varicose ulcers and IPs, although SEPS reduced the number of perforators remaining after 1 year.
本研究旨在阐明功能不全穿通静脉（IPs）在静脉性腿部溃疡中的作用。本短期报告重点关注筋膜下内镜穿通静脉手术（SEPS）或单纯隐静脉手术后的安全性、患者满意度以及 IPs 的命运。
纳入年龄在 30-78 岁之间、存在开放性或近期愈合的静脉溃疡、且存在功能不全隐静脉和 IPs 的患者，将其随机分为单纯隐静脉手术组或隐静脉手术联合 SEPS 组。术后 6-9 个月行对照性双功能超声检查，术后 1 周、3 个月和 12 个月进行临床随访，并在每次临床就诊时完成标准问卷。
共纳入 75 例患者，其中 37 例行 SEPS，38 例行单纯隐静脉手术。SEPS 使手术时间延长了 15 分钟（P = 0.003）。双功能超声成像显示，单纯隐静脉手术组中剩余的 IPs 明显更多（P < 0.001）。与术前扫描相比，SEPS 组中腿部 IPs 消失的比例明显高于单纯隐静脉手术组（分别为 36 例中的 21 例和 37 例中的 7 例；P < 0.001）。两组之间没有其他主要结局差异。
在存在静脉曲张溃疡和 IPs 的患者中，与单纯隐静脉手术相比，联合 SEPS 并不能带来短期临床获益，尽管 SEPS 减少了 1 年后残留的穿通静脉数量。
