Scriven J M, Bianchi V, Hartshorne T, Bell P R, Naylor A R, London N J
Department of Surgery, University of Leicester, U.K.
Eur J Vasc Endovasc Surg. 1998 Aug;16(2):148-52. doi: 10.1016/s1078-5884(98)80157-3.
To determine the clinical efficacy and local haemodynamic effects of perforating vein surgery in ulcerated limbs with combined deep and perforating vein incompetence.
Prospective, interventional study.
Seven ulcerated limbs with combined primary deep and perforating vein incompetence were studied. Clinical efficacy was determined by ultimate ulcer healing and reduction in ulcer area, local haemodynamics were assessed at three sites with photoplethysmographic 90% venous refilling times (PPG RT90); both assessments were performed pre- and 1-month postoperatively.
None of the ulcers healed following perforating vein surgery, the median (range) ulcer areas pre- and postoperatively were 31 (7-685) cm2 and 35.5 (7-796) cm2 (Wilcoxon p = 0.07). Preoperative PPG RT90 demonstrated a global abnormality of venous function at all sites examined that persisted after perforating vein surgery.
In the presence of deep venous incompetence perforating vein surgery had no influence on venous function or ulcer healing. We conclude that perforating vein surgery is not indicated for the treatment of venous ulceration in limbs with primary deep venous incompetence.
确定在合并深静脉和穿支静脉功能不全的溃疡肢体中行穿支静脉手术的临床疗效及局部血流动力学效应。
前瞻性干预性研究。
对7例合并原发性深静脉和穿支静脉功能不全的溃疡肢体进行研究。通过溃疡最终愈合情况及溃疡面积缩小来确定临床疗效，采用光电容积描记法测量90%静脉再充盈时间（PPG RT90）在三个部位评估局部血流动力学；术前及术后1个月均进行上述两项评估。
穿支静脉手术后溃疡均未愈合，术前及术后溃疡面积中位数（范围）分别为31（7 - 685）cm²和35.5（7 - 796）cm²（Wilcoxon检验p = 0.07）。术前PPG RT90显示所有检查部位静脉功能均存在整体异常，穿支静脉手术后该异常仍持续存在。
在存在深静脉功能不全的情况下，穿支静脉手术对静脉功能及溃疡愈合无影响。我们得出结论，对于原发性深静脉功能不全的肢体静脉溃疡，穿支静脉手术并非治疗选择。
