| 韩林霖,韩 天,陈 曦,孙若男,汪佳旭,杨秀华.超声引导射频消融联合外科微创手术治疗下肢静脉曲张的疗效及预后影响因素分析[J].,2021,(7):1287-1291 |
| 超声引导射频消融联合外科微创手术治疗下肢静脉曲张的疗效及预后影响因素分析 |
| Analysis of the Effect and Prognostic Factors of Ultrasound-guided Radiofrequency Ablation Combined with Minimally Invasive Surgery in the Ttreatment of Varicose Veins of Lower Extremities |
| 投稿时间：2020-06-27 修订日期：2020-07-24 |
| DOI：10.13241/j.cnki.pmb.2021.07.019 |
| 中文关键词: 下肢静脉曲张 交通支静脉 射频消融 静脉直径 前副隐静脉 |
| 英文关键词: Varicose veins Perforator veins Radiofrequency ablation Diameter of saphenous vein AASV |
| 基金项目:国家自然科学基金项目（81871362） |
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| 中文摘要: |
| 摘要 目的：评估超声引导射频消融术（Radio Frequency Ablation, RFA）联合外科微创手术治疗对下肢各类型浅静脉曲张的临床疗效，分析影响射频消融靶静脉闭合率的相关因素。方法：对 2018年6月至 2019年6月在我院住院的 73例下肢静脉曲张患者（共137条静脉）采用RFA闭合和外科微创手术治疗（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，评价治疗效果并分析相关影响因素及影响射频闭合率的相关因素。结果：对 137 条治疗后的患肢进行随访，平均随访时间为 6 个月，74名患者症状均有所缓解，患者治疗后的下肢静脉疾病诊断标准 CEAP分级(clinical-etiology-anatomic-pathophysiologic classification system，CEAP)均显著低于治疗前（P＜0.05）。统计分析发现年龄是CEAP术后降低的相关影响因素（P＜0.05）；术后并未发现严重并发症。术后共 13条患肢射频靶静脉段出现再通，联合手术的成功率为 90%。其中大隐静脉（Great Saphenous Vein，GSV）6条、前副隐静脉（Anterior Accessory Saphenous Vein，AASV）2条，小隐静脉(Small Saphenous Vein, SSV)5条，三种静脉的手术成功率分别为91%，89%，76%。通过Logistic回归单因素、多因素分析发现，靶静脉直径、静脉种类与射频消融再通相关。靶静脉直径越大，射频消融静脉段再通的可能性越大；三种静脉再通可能性的大小比较为SSV＞AASV＞GSV。结论：超声引导下肢浅静脉的射频消融闭合术联合交通支静脉的外科微创手术治疗是治疗静脉曲张的一种安全有效的方式。RFA治疗靶静脉再通的重要危险因素是靶静脉的术前直径以及静脉种类。 |
| 英文摘要: |
| ABSTRACT Objective: To evaluate the clinical effect of ultrasound-guided radiofrequency ablation combined with minimally invasive surgery on various types of varicose veins of lower extremities. Furthermore, To analyze the factors influencing the closure rate of target vein in radiofrequency ablation. Methods: From June 2018 to June 2019, 73 patients with varicose veins of lower extremities（137 veins）in our hospital were treated with radiofrequency ablation closure combined with minimally invasive surgery（Treatment of superficial veins of the leg with communicating veins and foam sclerotherapy by point stripping）, closed all kinds of superficial veins. All patients were followed by ultrasound at 6 months after operation Visit, evaluate the therapeutic effect and analyze the related factors, and analyze the related factors that affect the RFA closure rate. Results: The average follow-up time of 137 limbs after treatment was 6 months. The symptoms of 74 patients were relieved, and the CEAP grade of patients after treatment was significantly lower than that before treatment (P<0.05). Statistical analysis showed that age was the risk factor of postoperative decrease of CEAP (P<0.05), and no serious complications were found. The successful rate of combined operation was 90%. Among them, 6 were GSV, 2 were AASV, and 5 were SSV. The success rates of the three kinds of veins were 91%, 89%, 76% respectively. Through logistic regression analysis, we found that the diameter and type of the target vein were related to radiofrequency ablation recanalization. The larger the diameter of the target vein is, the greater the possibility of recanalization is. The comparison of the three recanalization possibilities is SSV > AASV > GSV. Conclusion: Ultrasound guided radiofrequency ablation of superficial veins of lower extremities, point stripping of communicating veins and foam sclerotherapy of superficial veins of the lower leg are safe and effective ways to treat varicose veins, and are suitable for GSV, AASV and SSV dysfunction. The important risk factors of radiofrequency ablation for target vein recanalization are the preoperative diameter of target vein and the type of vein. |
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