各種SEPS術式の紹介と手術適応

New SEPS procedures including one-port and two-port systems, and the operative indication

　下肢の一次性静脈瘤は最も普遍的な疾患の1つで，多くは皮膚病変を伴わないが，慢性静脈不全や静脈瘤の再発には潰瘍やlipodermatosclerosisなどの皮膚病変を伴うことが多く，この場合には不全穿通枝の切離が有効な外科治療である．従来のLinton法などによる筋膜下穿通枝結紮は創合併症の多さから，現在では内視鏡的筋膜下不全穿通枝切離術（subfascial endoscopic perforator surgery：SEPS）が行われ，よい結果が得られている．本稿では最新のone port systemとtwo port systemを含むSEPS術式の紹介と，不全穿通枝切離の意義，手術適応および今後の展望について述べる．

Large numbers of patients are seen with gross incompetent varicose veins of the great and small saphenous systems, yet the majority have healthy skin around the ankles. On the other hand, the development of chronic venous insufficiency and recurrent varicose veins are complicated by liposcleroderma or skin ulceration. For these conditions, the severing of incompetent perforating veins between superficial and deep systems is an effec-tive surgical treatment; however, the high rate of wound complications after direct ligation of incompetent per-forating veins is a significant problem.