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首页> 外文期刊>Surgical Endoscopy >Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure.
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Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure.

机译：使用筋膜内镜下穿支静脉手术治疗严重的慢性静脉功能不全。

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BACKGROUND: Before 1985, corrective surgical procedures for patients with chronic venous insufficiency and venous ulcers were performed using long incisions through diseased skin and subcutaneous tissues. The procedure, involving ligation of incompetent perforator veins, known as "the Linton operation," often was complicated by wound infections and poor healing. This changed in 1985 when G. Hauer demonstrated a new surgical technique for direct visual identification of the incompetent perforator veins using an endoscope in the subfascial space. This seminal contribution marked the advent of subfascial endoscopic perforator vein surgery (SEPS). METHODS: From 1996 to 2004, the authors group prospectively collected data on 110 patients with chronic venous insufficiency who underwent a SEPS procedure. Preoperative assessment of the limb's vascular status consisted of color-flow duplex ultrasound imaging and ascending and descending phlebography to locate vein valve incompetence, along with venous mapping. The ages of the patients ranged from 42 to 82 years (mean, 60 years). A total of 128 limbs underwent the SEPS procedure in the cohort of 110 patients. According to CEAP classification for venous limb disease, 60 limbs belonged to group C5 (skin changes, pigmentation, venous eczema, lipodermatosclerosis, healed ulcer) and 68limbs to group C6 (skin changes and active ulceration). RESULTS: The 110 patients underwent 128 SEPS procedures without significant morbidity. Of the 68 limbs in class C6, 54 showed ulcer healing within the follow-up period of 12 weeks. The remaining 14 limbs in class C6 achieved ulcer healing within 24 weeks. In this latter group, 10 patients had venous ulcers larger than 4 cm in diameter. These patients underwent a split-thickness skin graft at the time the SEPS procedure was performed. The grafts remained healed during a 2-year follow-up period. CONCLUSIONS: This study demonstrated the effectiveness of the SEPS procedure when incorporated into the overall treatment strategy for patients with chronic venous insufficiency. Minimal postoperative complications accompanied by ulcer healing and relief of lower extremity symptoms were achieved for all the patients, underscoring the important role of incompetent perforator veins in the formation of chronic venous insufficiency.
机译：背景：1985年以前，通过对患病的皮肤和皮下组织进行长切口手术，对患有慢性静脉功能不全和静脉溃疡的患者进行了矫正手术。该过程涉及结扎无能力的穿支静脉，称为“林顿手术”，通常因伤口感染和愈合不良而变得复杂。 1985年，G。Hauer展示了一种新的外科手术技术，可以通过筋膜下腔内窥镜直接视觉识别不合格的穿支静脉。这一创举标志着筋膜下内窥镜穿支静脉手术（SEPS）的出现。方法：从1996年至2004年，作者小组前瞻性收集了110例接受SEPS手术的慢性静脉功能不全患者的数据。术前评估肢体的血管状态包括彩色流双功超声成像和静脉造影检查静脉瓣膜功能不全，以定位静脉瓣膜功能不全。患者的年龄为42至82岁（平均60岁）。 110例患者中共有128条肢体接受了SEPS手术。根据CEAP对静脉肢体疾病的分类，C5组有60条肢体（皮肤改变，色素沉着，静脉湿疹，脂肪性皮肤硬化，溃疡愈合），C6组有68条肢体（皮肤改变和活动性溃疡）。结果：110例患者接受了128例SEPS手术，无明显发病率。在C6类的68条肢体中，有54条在12周的随访期内显示溃疡愈合。 C6类的其余14条肢在24周内实现了溃疡愈合。在后一组中，有10名患者的静脉溃疡直径大于4厘米。这些患者在进行SEPS手术时进行了厚皮移植。在2年的随访期内，移植物一直处于愈合状态。结论：本研究证明了将SEPS程序纳入慢性静脉功能不全患者的整体治疗策略中的有效性。所有患者均实现了最小的术后并发症，并伴有溃疡愈合和下肢症状缓解，这强调了无能力的穿支静脉在慢性静脉功能不全形成中的重要作用。

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