Iafrati M D, Welch H J, O'Donnell T F
Division of Vascular Surgery, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
J Vasc Surg. 1997 Jun;25(6):995-1000; discussion 1000-1. doi: 10.1016/s0741-5214(97)70122-8.
Early results of subfascial endoscopic perforator surgery (SEPS) were examined. Data on ulcer healing, complications, and costs are presented.
Data were prospectively collected for all patients who underwent SEPS at our institution. A concurrent control group was not available because primary open perforator ligation is no longer performed at our hospital. Preoperative assessment included duplex scanning (valve closure times and perforator mapping), plethysmography, and phlebography. Completeness of therapy was assessed with postoperative duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and facilities management, are reported.
Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a second procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 18 (11%), and lipodermatosclerosis with edema (class 4) in two. Deep venous insufficiency was present in 14 of 18 (78%). The number of perforating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing occurred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not improved. There were no new ulcers. Residual perforating veins were noted in four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher than those associated with limited-incision open perforator ligation ($2570 vs $1883).
These preliminary data suggest that when used as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no recurrent ulceration in this series. Increased operating room costs associated with longer operations and greater disposable expenses will likely be overcome by shortened length of stay and diminished wound complications. These findings emphasize the importance of ligating all incompetent perforating veins, as ulcer healing was never achieved when residual perforating veins were found at follow-up.
研究筋膜下内镜交通支离断术（SEPS）的早期结果。并给出溃疡愈合、并发症及费用方面的数据。
前瞻性收集在我院接受SEPS的所有患者的数据。由于我院不再进行原发性开放交通支结扎术，因此未设同期对照组。术前评估包括双功扫描（瓣膜关闭时间及交通支定位）、体积描记法及静脉造影。通过术后交通静脉双功成像评估治疗的完整性。术后监测临床状况，并报告实际费用，包括设备、人员及设施管理费用。
15例患者共进行了18次手术（平均年龄52岁；范围42至65岁）。2例患者接受双侧SEPS，1例患者在同一条腿上进行了第二次手术。18条肢体中有14条（78%）存在活动性溃疡（6级），18条中有2条（11%）为近期愈合的溃疡（5级），2条存在脂肪皮肤硬化伴水肿（4级）。18条中有14条（78%）存在深静脉功能不全。每条腿结扎的交通静脉数量为0至12条（平均4.3条）。随访时间为3至64周（平均22周）。14条肢体中有8条（57%）在平均14周时溃疡完全愈合。14条中有4条（29%）溃疡面积缩小，2条肢体无改善。无新发溃疡。18条肢体中有4条发现残留交通静脉。有残留交通静脉的肢体均未实现溃疡完全愈合。手术室费用高于有限切口开放交通支结扎术（2570美元对1883美元）。
这些初步数据表明，当作为纠正深、浅静脉功能不全治疗方案的一部分使用时，SEPS可实现较高的伤口愈合率，本系列中无复发性溃疡。与手术时间延长及一次性费用增加相关的手术室费用增加，可能会因住院时间缩短及伤口并发症减少而得到克服。这些发现强调了结扎所有功能不全交通静脉的重要性，因为随访时发现残留交通静脉时溃疡从未愈合。
