腔镜筋膜外下肢静脉交通支离断术的临床应用探讨

目的:探讨腔镜筋膜外交通支离断术(epifascial laparoscopic perforator surgery,ELPS)的临床应用价值。方法:回顾性分析我院2005年6月至2007年1月采用腔镜筋膜外交通支离断术治疗慢性下肢静脉功能不全12例共14条肢体的临床资料。采用彩色多普勒超声、彩色多普勒剖面流速图、空气体积描记仪、临床分级和静脉功能评分等方法在手术前后对患肢静脉交通支离断情况、静脉功能和术后并发症等状况进行分析。对所有患者进行随访,分析手术的长期效果。结果:本组共离断小腿交通静脉42支,平均3支/肢体,功能不全的交通支67.4%(29/43)距内踝20cm以内;手术前后静脉功能综合评分均值、手术前后彩超剖面流速图静脉返流量均值和空气体积描记仪3项指标术前、后均值比较均有统计学差异(P<0.01)。术后并发症发生率低。随访3～15个月,随访率100%。全组浅静脉曲张未见复发,6条溃疡肢体中有5条肢体溃疡全部愈合(83.3%)。比较患者术前与术后3个月的CEAP临床评分,除色素沉着无明显改善(P>0.05)外,其他临床表现均有明显改善(P<0.01)。结论:腔镜筋膜外交通静脉离断术治疗下肢慢性静脉功能不全在临床上的结果令人满意,在目前纠正深静脉瓣膜功能方面缺乏确切疗效的治疗方法时,是具有较高临床价值的微创技术手段,值得推广。

The clinical application of epifascial laparoscopic perforator surgery

Objective:Laparoscopic perforator surgery is a kind of new mini-invasive surgery for the treatment of severe chronic venous insufficiency(CVI).It has distinct advantages compared with traditional surgeries.Compared to the wide clinical application of subfascial endoscopic perforator surgery(SEPS),epifascial laparoscopic perforator surgery(ELPS) is applied and reported little.We took a preliminary attempt to ELPS and approached its value of clinical application.Methods:The clinical data of 12 cases(14 limbs) received ELPS in our hospital from Jun.2005 to Jan.2007 was analyzed.Color Doppler,Color Doppler Velocity Profile(CDVP),venography and air plethysmography(APG),CEAP classification,scoring of venous dysfunction(SVD) were applied to assess the status of the affected limbs before and after operation.A follow-up visit was carried out for all the patients to analyze the long-term effect of the ELPS.Results:Forty-two communicated veins(3/limb) were cut off in total and 67.4%(29/43)of the dysfunction veins were located in less than 20cm to the medial malleolus.The average SVD was (13.9±1.7) preoperatively,while (6.4±0.8) postoperatively(P<0.01).The average venous reflux volume by CDVP in pre-and post-operation were (61.2±7.7)ml/s vs.(45.6±5.7)ml/s respectively(P<0.01);and the average values of three indexes by APG in post-operation were significantly different from those in pre-iperation(P<0.01).The postoperative follow-up was made from 3 to 15 months with the follow-up rate of 100%(14/14 limbs).No limbs suffered from recurrent superficial varicose.Venous ulcer was cured in 5 limbs(83.3%).Ulcer healing time ranged from 10 to 91 days with the average time of (32±5) days.Comparing the CEAP clinical scores before and after ELPS,all clinical manifestation were greatly improved(P<0.01) except the pigmentation(P>0.05).Conclusions:The results of treatment for CVI with ELPS were satisfactory.ELPS should be generalized because of high clinical value.