| 摘要: |
| 目的 评价超声引导射频消融术（RFA）闭合大隐静脉（GSV）主干、点式剥脱治疗交通支静脉和泡沫硬化处理小腿部浅表静脉的联合手术的临床疗效；分析影响RFA治疗GSV主干的闭合率的相关因素，通过ROC曲线获得相关影响因素的界值点。方法 对2018年10月至2019年10月在我院住院的102例下肢静脉曲张患者（共168条患肢）采用射频消融闭合大隐静脉主干、点式剥脱治疗交通支静脉和泡沫硬化处理小腿部浅表静脉的联合治疗方法，所有患者在术后6个月进行超声随访，评价治疗效果，分析影响射频闭合率的相关因素，并计算其界值点。结果 对168条治疗后的患肢进行随访，平均随访时间为6个月，由同一名临床医生对其进行CEAP评级，以及同一名超声医师对其进行超声检查，共23条患肢仍然需要手术干预。其中12条患肢射频靶静脉段出现再通，2条患肢再发侧支静脉曲张，4条患肢再发小隐静脉曲张，5条患肢出现功能不全的交通支静脉。术后并未发现严重并发症，4条患肢超声显示皮下软组织水肿。联合手术的成功率为87%。逻辑回归分析发现，年龄、性别、CEAP分级、血压、血糖与较低的闭塞率之间没有关联，大隐静脉直径是射频消融术后再通的独立危险因素（P＜0.05）。绘制ROC曲线，确定影响射频术后GSV再通的直径的界值点是8.5mm。 结论 RFA闭合GSV主干、点式剥脱治疗交通支静脉和泡沫硬化处理小腿部浅表静脉的联合治疗的临床疗效显著；消融靶静脉再通的一个重要危险因素是大隐静脉的术前直径，直径≥8.5mm是射频术后GSV再通的界值点。因此，个性化手术方案的制订对于提高患者的疗效至关重要。 |
| 关键词: 超声引导 下肢静脉曲张 交通支静脉 射频消融 大隐静脉直径 |
| DOI： |
| 投稿时间：2020-07-22修订日期：2020-08-01 |
| 基金项目: |
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| Analysis of the efficacy and prognosis of ultrasound-guided radiofrequency ablation for lower extremity venous insufficiency |
| wangjiaxv,Zhang Wei,Han Tian,Han Linlin,Yang Xiuhua |
| (The First Affiliated Hospital of Harbin Medical University) |
| Abstract: |
| Purpose To evaluate the combination therapy effect of radiofrequency ablation (RFA) for the treatment of the great saphenous vein, stripping surgery for incompetent perforator veins and foam sclerosis treatment for shallow veins. Furthermore, to analyze the factors affecting the closure rate of the great saphenous vein trunk after radiofrequency ablation，The boundary value points of the influencing factors were obtained by ROC curve.Methods 102 cases of lower extremity varices (168 limbs) in our hospital from October 2018 to October 2019 treated with combination therapy of radiofrequency ablation, stripping surgery and foam sclerotherapy were enrolled in this survey. The follow-up of all patients was carried out by ultrasound imaging after 6 months to evaluate the treatment effect and analyze the factors related to the closure rate of RFA，and calculate its boundary point.Results All the 168 treated limbs were followed up for 6 months. CEAP was rated by the same clinician,and ultrasound was performed by the same sonographer. Results indicated that 23 limbs still required surgical intervention. Among them, 12 limbs were recanalized at the RFA site in ultrasound imaging, however, without obvious clinical symptoms; Collateral varicose veins recurrence in 2 limbs; small saphenous varicose veins appear in 4 limbs; and the dysfunction traffic veins were seen in 5 limbs. No serious complications were found after operation. Only subcutaneous soft tissue edema of four limbs were found under the monitoring with ultrasound. The success rate of combined surgery was 87%. Logistic regression analysis indicated there were no association between age, gender, CEAP grade, blood pressure, blood glucose and lower occlusion rate. However, the diameter of saphenous vein was positively correlated with recanalization rate after radiofrequency ablation (P＜0.05).The ROC curve was drawn to determine the cutoff point for diameter affecting efficacy after radiofrequency surgery was 8.5mm. Conclusions The combination therapy effect of RFA for the great saphenous vein, stripping surgery for incompetent perforator veins and foam sclerosis for shallow veins is remarkable. An important risk factor of recanalization in RFA targeted vein is the preoperative diameter of great saphenous vein. Diameter ≥8.5mm is the cutoff point for postoperative recanalization of RFA.Therefore, personalized surgical plan is essential to improve the therapeutic effect of the surgery. |
| Key words: Ultrasound guidance Varicose veins Perforator veins Radiofrequency ablation Diameter of great saphenous vein |
