Application of Endoscope in Treatment for Venous Ulcer in Lower Limb_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 JIANG Ming , YAN Shide , QIAN Xiaoxing , LIU Xianluo.

Department of General Surgery, The Second People’s Hospital of Hefei City, Hefei 230011, Anhui Province, China;

Corresponding author：

JIANG Ming, Email: jiangming8088@yeah.net

Keywords：

Endoscope; Perforator vein; Subfascial endoscopic perforator surgery; Venous ulcer

Video：

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ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.

Citation： JIANG Ming,YAN Shide,QIAN Xiaoxing,LIU Xianluo.. Application of Endoscope in Treatment for Venous Ulcer in Lower Limb. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(12): 1288-1291. doi: Copy

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14.	时德, 赵渝.下肢慢性静脉功能不全治疗的再认识 [J].中国普外基础与临床杂志, 2009, 16(6): 421424.
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18.	田卓平, 蒋米尔, 张伯津, 等. 下肢深静脉造影临床应用的评价(7 908条患肢造影资料分析) [J]. 中国现代普通外科进展, 2001, 4(1): 5153.
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22.	李昭辉, 景在平, 陈泉, 等. 腔镜深筋膜下交通支结扎+溃疡周围环缝术治疗慢性下肢静脉性溃疡23例 [J]. 中国普外基础与临床杂志, 2008, 15(6): 416417.
23.	Ting AC, Cheng SW, Ho P, et al. Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery [J]. Surg Endosc, 2003, 17(8): 13141318.
24.	王深明, 胡作军. 内镜筋膜下交通静脉结扎术治疗静脉性溃疡 [J]. 临床外科杂志, 2005, 13(9): 545546.
25.	姚燕丹, 王深明, 林少芒, 等. 内镜在下肢慢性静脉功能不全治疗中的应用研究 [J]. 中国内镜杂志, 2004, 10(7): 1214.

1. 张柏根. 下肢慢性静脉功能不全与CEAP分类系统 [J]. 外科理论与实践, 2005, 10(1): 13.
2. 陆民. 外科手术在治疗慢性静脉功能不全中的作用 [J]. 临床外科杂志, 2008, 16(5): 299301.
3. 王深明, 姚陈. 慢性静脉性溃疡的研究现状与诊治策略 [J]. 中国医学科学院学报, 2007, 29(1): 58.
4. 乔正荣, 时德. 下肢慢性静脉功能不全发病机理的临床研究 [J].中国普外基础与临床杂志, 2003, 10(3): 249252.
5. Lurie F, Kistner RL, Eklof B. Surgical management of deep venous reflux [J]. Semin Vasc Surg, 2002 ,15(1): 5056.
6. Linton RR. The communicating veins of the lower leg and the operative technic for their ligation [J]. Ann Surg, 1938, 107(4): 582593.
7. 蒋米尔, 陆信武. 下肢静脉疾病诊治策略的演变和时代意义 [J]. 上海医学, 2009, 32(8): 646649.
8. Gloviczki P. Subfascial endoscopic perforator vein surgery: indications and results [J].Vasc Med, 1999, 4(3): 173180.
9. Hauer G. Endoscopic subfascial discussion of perforating veins-preliminary report [J]. Vasa, 1985, 14(1): 5961.
10. Gloviczki P, Bergan JJ, Rhodes JM, et al. Midterm results of endoscopic perforator vein interruption for chronic venous insufficiency: lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group [J]. J Vasc Surg, 1999, 29(3): 489502.
11. 张培华, 李维敏. 下肢交通静脉瓣膜功能不全//张培华, 蒋米尔. 临床血管外科学 [M]. 第2版. 北京: 科学出版社, 2007: 554557.
12. Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency [J]. J Vasc Surg, 2003, 37(3): 545551.
13. Bianchi C, Ballard JL, AbouZamzam AM, et al. Subfascial endoscopic perforator vein surgery combined with saphenous vein ablation: results and critical analysis [J]. J Vasc Surg, 2003, 38(1): 6771.
14. 时德, 赵渝.下肢慢性静脉功能不全治疗的再认识 [J].中国普外基础与临床杂志, 2009, 16(6): 421424.
15. 朱家源, 唐冰, 朱斌, 等.下肢静脉性溃疡综合处理的效果分析 [J]. 中华外科杂志, 2006, 44(19): 13401341.
16. 张强, 王跃东, 李君达. 电视内镜穿通支离断术治疗下肢复发性静脉性溃疡 [J]. 中华外科杂志, 1999, 37(7): 423.
17. 黄英, 蒋米尔, 张培华. 下肢浅静脉曲张的微创治疗 [J]. 外科理论与实践, 2004, 9(1): 7677, 83.
18. 田卓平, 蒋米尔, 张伯津, 等. 下肢深静脉造影临床应用的评价(7 908条患肢造影资料分析) [J]. 中国现代普通外科进展, 2001, 4(1): 5153.
19. Uncu H. Subfascial endoscopic perforator vein surgery using balloon dissector and saphenous vein surgery in chronic venous insufficiency [J]. Phlebology, 2007, 22(3): 131136.
20. Kumar A, Agarwal PN, Garg PK. Evaluation of subfascial endoscopic perforator vein surgery (SEPS) using harmonic scalpel in varicose veins: an observational study [J]. Int J Surg, 2009, 7(3): 253256.
21. 胡三元主译. 经内镜筋膜下下肢交通静脉结扎术//胡三元主译. 腹腔镜外科学 [M]. 第2版. 济南: 山东科学技术出版社, 2006: 638643.
22. 李昭辉, 景在平, 陈泉, 等. 腔镜深筋膜下交通支结扎+溃疡周围环缝术治疗慢性下肢静脉性溃疡23例 [J]. 中国普外基础与临床杂志, 2008, 15(6): 416417.
23. Ting AC, Cheng SW, Ho P, et al. Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery [J]. Surg Endosc, 2003, 17(8): 13141318.
24. 王深明, 胡作军. 内镜筋膜下交通静脉结扎术治疗静脉性溃疡 [J]. 临床外科杂志, 2005, 13(9): 545546.
25. 姚燕丹, 王深明, 林少芒, 等. 内镜在下肢慢性静脉功能不全治疗中的应用研究 [J]. 中国内镜杂志, 2004, 10(7): 1214.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Endoscope in Treatment for Venous Ulcer in Lower Limb

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