射频消融治疗下肢静脉曲张合并髂静脉压迫的短期疗效分析  

Analysis of the short-term efficacy of radiofrequency ablation for lower extremity varicose veins combined with iliac vein compression

作　　者：王雪青 刘建通 林超 张福先[2] 厉祥涛 WANG Xueqing;LIU Jiantong;LIN Chao;ZHANG Fuxian;LI Xiangtao(Department of Surgery,Beijing Nuclear Industry Hospital,Beijing 100045,China;Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]北京核工业医院外科,北京100045 [2]首都医科大学附属北京世纪坛医院血管外科,北京100038

出　　处：《中国普通外科杂志》2023年第12期1919-1926,共8页China Journal of General Surgery

基　　金：北京世纪坛医院青年基金资助项目(2020-q16)。

摘　　要：背景与目的:目前,髂静脉压迫(IVC)支架植入指征尚不明确,此外,对于IVC合并下肢静脉曲张的患者,部分学者认为如果髂静脉狭窄处两端压力差不大(<2 mmHg),只要单纯处理下肢静脉曲张也能有效改善下肢症状。因此,本研究分析此类患者单纯行下肢静脉曲张射频闭合手术的短期临床结果。方法:回顾性分析2020年6月—2022年6月在首都医科大学附属北京世纪坛医院行下肢静脉曲张射频闭合手术的患者资料,根据髂静脉超声、CTV和下肢静脉造影检查,筛选出IVC伴侧支循环形成而压力差<2 mmHg的患者(IVC+静脉曲张组),并为其使用倾向性评分按照1∶3匹配单纯下肢静脉曲张患者(静脉曲张组)。主要终点指标为术后1周及3、6、12个月隐静脉主干闭塞率,次要终点指标包括术后6、12个月的静脉临床严重程度评分(VCSS)、慢性静脉功能不全生活质量问卷(CIVIQ-20)评分。结果:筛选出IVC+静脉曲张组29例,匹配静脉曲张组患者87例,两组患者基线资料差异无统计学意义(均P>0.05)。术后首次超声检查,两组患者隐静脉主干闭合率均为100.0%;术后3、6、12个月的随访时,静脉曲张组与IVC+静脉曲张组患者主干闭合率分别为100.0%vs.100.0%、97.7%vs.100.0%、98.8%vs.100.0%,差异无统计学意义(均P>0.05)。两组患者的VCSS评分与CIVIQ-20评分均较术前明显降低(均P<0.05),但两组间比较,差异均无统计学意义(均P>0.05)。两组均无深静脉血栓形成等严重不良事件,静脉曲张组与IVC+静脉曲张组术后总体并发症发生率差异无统计学意义(20.7%vs.24.1%,P=0.69)。结论:对于髂静脉狭窄处两端压力差不大的IVC合并下肢静脉曲张患者,进行隐静脉射频消融的微创治疗可以获得良好的短期效果,但其长期效果仍需进一步检验。Background and Aims:Currently,the indications for iliac vein compression(IVC)stent implantation remain unclear.In addition,for patients with combined IVC and lower extremity varicose veins,some scholars believe that if there is low pressure difference across the narrow segment of the iliac vein(<2 mmHg),simply treating lower extremity varicose veins can effectively improve lower limb symptoms.Therefore,this study was performed to analyze the short-term clinical outcomes of performing radiofrequency closure surgery for lower extremity varicose veins alone in such patients.Methods:The data of patients who underwent endovenous radiofrequency ablation for lower extremity varicose veins in Beijing Shijitan Hospital of Capital Medical University from June 2020 to June 2022 were retrospectively analyzed.According to iliac vein ultrasound,CTV,and lower extremity venography examinations,patients with IVC and collateral circulation formation with a pressure difference<2 mmHg(IVC+varicose veins group)were selected.Propensity score matching was then employed at a 1:3 ratio to match patients with lower extremity varicose veins only(varicose veins group).The primary endpoints were the occlusion rates of the saphenous vein trunk at 1 week and 3,6,and 12 months after operation.Secondary endpoints included venous clinical severity score(VCSS)and Chronic Venous Insufficiency Quality of Life Questionnaire(CIVIQ-20)scores at 6 and 12 months after operation.Results:A total of 29 patients were identified in the IVC+varicose veins group,matched with 87 patients in the varicose veins group.There were no statistically significant differences in baseline characteristics between the two groups(all P>0.05).After the first postoperative ultrasound examination,the occlusion rates of the saphenous vein trunk were 100.0%in both groups.At 3,6,and 12 months of follow-up,the occlusion rates in the varicose veins group vs.IVC+varicose veins group were 100.0%vs.100.0%,97.7%vs.100.0%,and 98.8%vs.100.0%,respectively,with no statistically significant d

关 键 词：May-Thurner综合征 静脉曲张 下肢 射频消融术 

分 类 号：R654.3[医药卫生—外科学]