Endoscopic Assisted Surgical Management of Superficial Thrombophlebitis in Patients with Primary Varicose Veins

以內視鏡手術治療原發性靜脈曲張併發的淺層靜脈栓塞炎

林運男(Yun-Nan Lin) ； 林幸道(Sin-Daw Lin) ； 黃書鴻(Shu-Hung Huang) ； 李書欣(Su-Shin Lee) ； 賴春生(Chung-Sheng Lai) ； 張高評(Kao-Ping Chang)

《臺灣整形外科醫學會雜誌》 21卷2期 (2012/06) Pp. 90-98

https://doi.org/10.7096/TJTSPS.201206.0090

摘要

背景：静脈曲張是慢性進行的疾病。在早期，患者大多數沒有症狀，除了有下肢血管的變形。症狀會隨著歲月而陸續出現，包括沉重感、發癢、疼痛、抽筋、皮下脂肪硬化和靜脈潰瘍。淺層靜脈栓塞炎（STP）是原發性靜脈曲張常見的併發症。在這項研究中，我們利用內視鏡手術治療STP的病人，將有病變的血管及其併發的栓塞全部摘除，其治療結果是肯定的。目的及目標：評估利用內視鏡手術治療原發性靜脈曲張併發的淺層靜脈栓塞炎（STP）患者的手術成果。材料及方法：在1264名患者接受原發性靜脈曲張手術中，有108名（8.5%）有STP的併發症；其中有32名男性和76名女性；年齡範圍從28到85歲。在接受手術之前，患者皆有STP的症狀。手術的進行是在下肢適切的部位，切一2.5公分至3公分的刀口，經由此刀口進入病灶手術，藉助於內視鏡光亮光源的照射及放大功能，我們利用特殊的剪刀將所有有病變的靜脈血管分離出來，也同時能找到引起病變的穿通枝，血管的分離直到看到正常的血管為止。此時，我們將所有有病變者完全分離後取出，而正常的血管則保存不受波及。結果：58%患者在手術隔天就出院了。住院時間很短，從3天到12天，平均只有4.8天。雖然45名患者失去追蹤，但仍有63名患者接受從6個月到72個月，平均20個月的追蹤。85.7%的患者對其術後結果都是滿意的；追蹤結果病人沒有復發靜脈曲張或淺層靜脈栓塞炎。術後疤痕很小且俱美觀效果。結論：以內視鏡手術治療原發性靜脈曲張併發的淺層靜脈栓塞炎的手術是一個新的，值得選用的治療方法。

並列摘要

Background:Varicose veins are chronically progressive disease. In the early stage, patients are free of symptoms except for the disfigurement of the involved lower limb. As time passes however, symptoms and signs, including a sensation of heaviness, itching, soreness, cramping, lipodermatosclerosis, and venous ulceration, will manifest themselves. Superficial thrombophlebitis (STP) is a common complication of primary varicose veins. In this study, radical removal of the varicosities and their associated thromboses were performed with the assistance of endoscopic surgery, and the results have been encouraging. Aim and objective:To evaluate the outcome of endoscopic surgery of superficial thrombophlebitis (STP) in patients with primary varicose veins. Materials and methods:Of 1264 patients who underwent surgery for primary varicose veins, 108 (8.5%) had the STP. There were 32 men and 76 women, ranging from 28 to 85 years old. Before the operations, patients were admitted for conservative management of their acute STP symptoms. The operations proceeded through access incisions (2.5-3.0 cm in length) of the skin overlying the varicose veins. With the aid of good illumination and magnified monitor view, the thrombosed veins, incompetent perforating veins and existing varicose veins were completely dissected, divided and excised radically.Results: The 58% of patients were discharged on the day after surgery. Hospital stays were short, varying from 3 days to 12 days with a mean of 4.8 days. Although 45 patients were lost to follow-up, the remaining 63 patients were followed up for from 6 months to 72 months with an average of 20 months. 85.7% of the follow-up patients were satisfactory about the outcome. There were no incidents of significant postoperative morbidity, and recurrence of varicose veins and STP. Scarring was minimal and aesthetically acceptable.Conclusions:This method may be a new and good alternative for management of STP in patients with primary varicose veins.

並列關鍵字

varicose veins ； superficial thrombophlebitis ； endoscopic surgery