Vashist M G, Malik Vijay, Singhal Nitin
Department of Surgery Pt. B.D.Sharma Post Graduate Institute of Medical Sciences Rohtak, 33/9 J Medical Campus, PGIMS, Rohtak, 124001 Haryana India.
Indian J Surg. 2014 Apr;76(2):117-23. doi: 10.1007/s12262-012-0675-5. Epub 2012 Jul 5.
The study was carried out to compare the efficacy of subfascial endoscopic perforator surgery (SEPS) and open subfascial ligation of perforators in varicose veins. This study was conducted on 100 patients of varicose veins from January 2006 to December 2010. Clinical scoring and color Doppler were performed in all the patients before surgery. Patients were divided into two groups: Group A and Group B alternately. Management of the perforators was done by subfascial endoscopic perforator surgery (SEPS) in Group A and by open subfascial ligation of perforators in Group B. Fifty patients were treated in each group. All the patients underwent ligation of incompetent saphenofemoral junction with stripping of long saphenous veins wherever the junction was incompetent with multiple ligation of superficial prominent veins. SEPS was done by two-port method without any tourniquet or balloon dissector. Total numbers of perforators ligated were 178 in Group A and 136 in Group B. Patients in both the groups got symptomatic relief of symptoms, but ulcer healing in 33 % patients in Group A was faster as compared to Group B. However, at 3 months of follow-up the ulcers healed in all the patients in both groups. Incidence of wound infection was higher in group B (16 %) as compared to group A (0 %). There were residual perforators in 8 % of patients on color Doppler at 3 months of follow-up in Group B while there was no residual incompetent perforator in Group A. Subfascial endoscopic perforator vein surgery is a safe and effective method for treating incompetent perforating veins. The number of perforators ligated in SEPS was more as compared to the open subfascial ligation group. Possibly some perforators may be missed on Doppler localization and missed ligation, which may be a cause of future recurrence in varicose veins. Early relief of symptoms in terms of ulcer healing was better in the SEPS group with less wound complication rate; however, all the ulcers healed in both the groups at 3 months of follow-up. Cosmetic results were equal in both the groups. Major advantage of SEPS was less incidence of wound complications and less incidence of residual incompetent perforators. Hence, SEPS should be added for the management of perforators along with conventional surgery in varicose veins.
本研究旨在比较筋膜下内镜交通支手术（SEPS）与开放性筋膜下交通支结扎术治疗静脉曲张的疗效。本研究于2006年1月至2010年12月对100例静脉曲张患者进行。所有患者术前均进行临床评分和彩色多普勒检查。患者交替分为两组：A组和B组。A组采用筋膜下内镜交通支手术（SEPS）处理交通支，B组采用开放性筋膜下交通支结扎术。每组治疗50例患者。所有患者均行大隐静脉股静脉瓣膜功能不全结扎术及大隐静脉剥脱术，若瓣膜功能不全则行多处浅表曲张静脉结扎术。SEPS采用双端口法，不使用止血带或球囊分离器。A组结扎的交通支总数为178个，B组为136个。两组患者症状均有缓解，但A组33%的患者溃疡愈合较B组更快。然而，在3个月的随访中，两组所有患者的溃疡均愈合。B组伤口感染发生率（16%）高于A组（0%）。随访3个月时，B组8%的患者彩色多普勒检查发现有残留交通支，而A组无残留功能不全的交通支。筋膜下内镜交通支静脉手术是治疗功能不全交通支静脉的一种安全有效的方法。与开放性筋膜下结扎组相比，SEPS结扎的交通支数量更多。可能在多普勒定位时会遗漏一些交通支，导致结扎遗漏，这可能是静脉曲张未来复发的一个原因。SEPS组在溃疡愈合方面症状缓解更早，伤口并发症发生率更低；然而，在3个月的随访中，两组所有溃疡均愈合。两组的美容效果相当。SEPS的主要优点是伤口并发症发生率较低，残留功能不全交通支的发生率较低。因此，在静脉曲张的治疗中，除了传统手术外，应增加SEPS来处理交通支。
