下肢静脈不全に対する内視鏡下穿通枝切離術

Endoscopic Division of Perforating Veins for Venous Insufficiency in the Lower Limbs

　炭酸ガス送気下に内視鏡的に穿通枝を切離する術式が本邦でも行われつつある．われわれは，穿通枝不全の3症例に対し筋膜下内視鏡的穿通枝切離術を施行し良好な結果を得た．エア・ターニケットを大腿に巻き駆血したのち，下腿内側に2本のトロッカーを挿入し，炭酸ガス送気下に穿通枝を露出した．穿通枝は容易に同定可能であり，クリッピングののち切離した．切離した穿通枝は2〜4本，大腿駆血時間は45〜79分であった．合併症はなく，9〜14日目に退院した．全例で症状の軽快，病変の改善がみられた．本術式は，従来の方法に比べて小さい切開創で施行可能であり，また皮膚病変のない部位より不全穿通枝を処理でき，有用な術式と思われる．

Endoscopic approaches to division of perforating veins with carbondioxide insufflation have recently been employed in Japan. We performed subfascial endoscopic division of perforating veins in three patients with chronic venous insufficiency and obtained good results. Two 10-mm ports were placed through two small incisions made just below the knee. Carbon-dioxide was insufflated into the subfascial space to improve visualization. A pneumatic thigh tourniquet was used to obtain a bloodless field. Perforating veins were easily visualized between the muscle and the fascia. They were divided after placement of clips.