Sparks S R, Ballard J L, Bergan J J, Killeen J D
Division of Vascular Surgery, Loma Linda University Medical Center, CA 92354, USA.
Ann Vasc Surg. 1997 Jul;11(4):367-73. doi: 10.1007/s100169900062.
Efficacy of subfascial endoscopic perforator vein surgery (SEPS) in assisting the healing of venous ulcers was determined. During the period June 1995 to May 1996, 19 limbs in 17 patients were treated by SEPS. Thirteen limbs had open ulcers (class 6), five limbs had healed ulcers (class 5), and one limb had severe lipodermatosclerosis (class 4). There were nine male and eight female patients (average age 58, range 33-86). One male had bilateral open ulcers and one female had one open and one healed ulcer. Open ulcers had been present for an average duration of 4.4 years (range 1-14 years). The average ulcer size was 2.8 x 2.2 cm (range 1 x 1 cm to 12 x 6 cm). All operations were conducted on an outpatient basis. At surgery an attempt was made to correct all superficial venous pathophysiology. In addition to SEPS, 12 limbs (63%) had greater saphenous vein (GSV) stripping and 15 patients (79%) had stab avulsion of painful varicose veins. The average number of perforators ligated during SEPS was 3.68 (range 2-8). All active ulcers healed within 90 days. The mean time to healing was 30.5 days (range 6-90 days). Minor postoperative complications (one groin hematoma, three wound infections) occurred in four limbs (21%). There have been no ulcer recurrences during follow-up (mean 8.6 months, range 3-16 months). Outpatient SEPS is an important adjunct in the treatment of chronic venous insufficiency. Experience in this group of 19 limbs strongly suggests that SEPS appears to accelerate the healing of venous ulcers compared to historical controls.
确定了筋膜下内镜交通静脉手术（SEPS）在促进静脉性溃疡愈合方面的疗效。在1995年6月至1996年5月期间，对17例患者的19条肢体进行了SEPS治疗。其中13条肢体有开放性溃疡（6级），5条肢体溃疡已愈合（5级），1条肢体有严重脂肪皮肤硬化症（4级）。患者中男性9例，女性8例（平均年龄58岁，范围33 - 86岁）。1例男性有双侧开放性溃疡，1例女性有1个开放性溃疡和1个已愈合溃疡。开放性溃疡平均存在时间为4.4年（范围1 - 14年）。溃疡平均大小为2.8×2.2厘米（范围1×1厘米至12×6厘米）。所有手术均在门诊进行。手术时试图纠正所有浅表静脉病理生理状况。除SEPS外，12条肢体（63%）进行了大隐静脉（GSV）剥脱术，15例患者（79%）对疼痛性静脉曲张进行了点状剥脱术。SEPS期间平均结扎交通静脉数量为3.68条（范围2 - 8条）。所有活动性溃疡均在90天内愈合。平均愈合时间为30.5天（范围6 - 90天）。4条肢体（21%）出现轻微术后并发症（1例腹股沟血肿，3例伤口感染）。随访期间（平均8.6个月，范围3 - 16个月）无溃疡复发。门诊SEPS是慢性静脉功能不全治疗中的一项重要辅助手段。这组19条肢体的经验有力表明，与既往对照相比，SEPS似乎能加速静脉性溃疡的愈合。
