Management of Primary Varicose Veins with the Assistance of Endoscopic Surgery: Its Role in the Treatment of Venous Ulceration

內視鏡手術對於治療原發性下肢靜脈曲張及靜脈性潰瘍所扮演的角色

王陳玄(Hsuan Wangchen) ； 林幸道(Sin-Daw Lin) ； 李書欣(Su-Shin Lee) ； 張高評(Kao-Ping Chang) ； 孫一峰(I-Feng Sun) ； 王文禾(Wen-Her Wang) ； 賴春生(Chung-Sheng Lai)

《中華民國整形外科醫學會雜誌》 17卷2期 (2008/06) Pp. 127-137

https://doi.org/10.7096/JPSA.200806.0127

摘要

目的：內視鏡手術治療原發性靜脈曲張已經得一個令人鼓舞的結果，可以有非常低的復發率。這次的研究是在進一步評估內視鏡手術治療原發性靜脈曲張合併有皮膚潰瘍的結果。
材料和方法：從1997年2月到2006年12月，91名病人中的103肢發生原發性靜脈曲張同時合併有皮膚潰瘍（C5和C6病灶）的患肢接受了內視鏡手術治療。這些患者的平均年齡是58.1（範圍28-87）歲。C5和C6病灶數目分別為55和48。87名患者中的97肢患肢完成後續追蹤，追蹤時間從2個月到108個月。術後皮膚潰瘍的癒合及復發的結果以Kaplan-Meier生存分析法進行統計研究。
結果：在接受後續追蹤的97肢患肢之中，百分之97.9%得到最初的潰瘍癒合，分別是C5病灶的50肢患肢和C6病灶的45肢患肢，平均潰瘍癒合時間分別為11.3和15.2星期。總復發例數是5，平均潰瘍復發時間是35.8月，五年的復發率推估是7.3%。總共只有兩個病例的潰瘍沒有癒合。同時也發現到，在潰瘍的皮膚下面或傷口的底部，總會有成簇的不正常曲張靜脈及變異的穿通枝。根除這些病變血管，潰瘍才會癒合且不再復發。
結論：在原發性靜脈曲張同時合併有皮膚潰瘍的患者，接受內視鏡手術治療確實達到了極佳潰瘍治療結果。此外，經由內視鏡所提供放大及清晰的影像，靜脈曲張和靜脈性潰瘍的關係得以確定。

並列摘要

Purpose: Primary varicose veins have been treated using endoscopic surgery and achieved an encouraging result, with very low incidence of recurrence. In this study, the result of endoscope-assisted operation for primary varicose veins with venous ulceration was evaluated.
Materials and Methods: From February 1997 to December 2006, 103 legs in 91 patients of primary varicose veins with skin ulceration (C5 and/or C6 lesions) were treated with the assistance of endoscopic surgery. The mean age of these patients at the time of operation was 58.1 (range 28-87) years. The numbers of C5 and C6 lesions were 55 and 48 respectively. A total of 97 legs in 87 patients received complete follow-up. The follow-up period ranged from 2 to 104 months. The results for the rate of ulcer healing and recurrence were analyzed with the Kaplan-Meier survival analysis.
Results: Among the 97 legs receiving complete follow-up, initial ulcer healing was achieved in 95 legs (97.9%), including 50 legs in the C5 group and 45 legs in the C6 group. The mean time for ulcer healing was 11.3 and 15.2 weeks in C5 and C6 groups respectively. The total number of recurrences was 5 and the mean time of recurrence was 35.8 months. The 5-year ulcer recurrence rate was 7.3%. Only two legs in two patients did not heal completely after the operation in this series. This study revealed that there were always clustered varicose veins with variable incompetent perforating vessels running immediately beneath the ulcerated skin and/or at the base of the ulcer. To achieve a complete and non-recurrent ulcer healing, radical excision of these varicose veins was mandatory.
Conclusion: In the treatment of primary varicose veins with ulceration, surgery with assistance of the endoscope achieved an excellent ulcer healing rate with low recurrence of ulcerations. Besides, with the advantages of the endoscope providing a magnified monitoring view with good illumination, the relationship between varicose veins and the venous ulcer was also established. This is a good alternative for the treatment of venous ulceration.

並列關鍵字

venous ulcer ； stasis ulcer ； varicose vein ； endoscopic surgery