超声引导射频消融治疗下肢静脉功能不全的疗效及预后影响因素分析  

Analysis of the efficacy and prognosis influence factors of ultrasound-guided radiofrequency ablation for lower extremity venous insufficiency

作　　者：汪佳旭 张巍[1] 韩天 韩林霖 杨秀华[1] WANG Jiaxu;ZHANG Wei;HAN Tian;HAN Linlin;YANG Xiuhua(Department of A bdominal Ultrasound,the First Affliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第一医院腹部超声科,哈尔滨市150000

出　　处：《临床超声医学杂志》2021年第5期342-346,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声引导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联合手术的临床疗效,分析影响射频消融术后靶静脉再通的相关因素。方法选取我院102例下肢静脉曲张患者(共168条患肢),均采用超声引导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浅表静脉的联合治疗,所有患者均于术后6个月行超声随访,评价治疗效果;Logistic回归分析影响射频闭合率的相关因素;绘制受试者工作特征(ROC)曲线分析相关影响因素的截断值及诊断效能。结果 168条患肢术后6个月随访,共23条患肢仍需手术干预,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。联合手术治疗成功率为87%。Logistic回归分析发现,大隐静脉术前直径是超声引导射频消融术后再通的独立影响因素(P<0.05);年龄、性别、CEAP分级、血压、血糖均与之无关。ROC曲线分析显示,导致患者射频消融术后靶静脉再通的大隐静脉术前直径的截断值为8.5 mm,影响射频消融术后疗效的ROC曲线下面积及95%可信区间为0.764(0.623~0.905),敏感性为75%,特异性为80.8%。结论超声引导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联合治疗的临床疗效显著;大隐静脉术前直径是超声引导射频消融靶静脉再通的重要影响因素。ObjectiveTo evaluate the therapeutic effect of combined radiofrequency ablation(RFA)/stripping surgery for the treatment of the great saphenous vein,incompetent perforator veins and foam sclerosis for shallow veins.And to analyze the factors affecting the closure rate of the great saphenous vein trunk after radiofrequency ablation.Methods hundred and two patients with varicose veins of lower extremities(168 limbs)were selected. All patients were treated by combination therapy of ultrasound guided radiofrequency ablation for the great saphenous vein,stripping surgery for incompetent perforator veins and foam sclerosis for shallow veins.The patients were followed up for 6 months after operation.The Logistic regression analysis was used to analyze the factors affecting the radiofrequency closure rate.The receiver operating characteristic(ROC)curve was drawn to analyze the cut-off value and diagnostic efficacy of related factors.ResultsA total of 23 limbs still needed surgical intervention after 6 months follow up.Among them,12 limbs had recanalization in the radiofrequency-target vein segment,2 limbs had recurrent collateral varices,4 limbs had recurrent small saphenous varices,and 5 limbs had dysfunctional communicating veins.No serious complication was found after the operation,and 4 limbs had subcutaneous soft tissue edema.The successful rate of combined therapy was 87%. Logistic regression analysis showed that the diameter of great saphenous vein before operation was an independent risk factor of recanalization after ultrasound-guided radiofrequency ablation(P<0.05),while the factors including age,gender,CEAP grading,blood pressure and blood glucose were not associated with closure rate.ROC curve analysis showed that the cut-off value of preoperative diameter of the great saphenous vein was 8.5 mm,and the area under ROC curve about the affecting efficacy of ultrasound guided radiofrequency ablation was 0.764(95% confidence interval:0.623~0.905),sensitivity was 75.0% and specificity was 80.8%.ConclusionThe combin

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 术前 

分 类 号：R445.1[医药卫生—影像医学与核医学]