彩超引导下电凝术治疗慢性下肢静脉功能不全病理性穿通静脉的中期效果研究  

Mid-term efficacy of color Doppler ultrasound-guided electrocoagulation therapy for pathological perforating veins in chronic venous insufficiency of lower extremity

作　　者：周芷若 白佳冀 王海涛[1] Zhou Zhiruo;Bai Jiaji;Wang Haitao(Department of Vascular Surgery,The Second Affiliated Hospital of Harbin Medical University,Harbin 150086,Heilongjiang,China)

机构地区：[1]哈尔滨医科大学附属第二医院血管外科,黑龙江哈尔滨150086

出　　处：《中国血管外科杂志(电子版)》2025年第1期12-16,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：哈尔滨医科大学横向课题(070500020409)。

摘　　要：目的评估慢性下肢静脉功能不全患者静脉腔内热消融联合彩色多普勒超声引导下套管针经皮穿刺电凝术治疗病理性穿通静脉的中期临床疗效及安全性。方法回顾性收集2017年9月至2023年9月哈尔滨医科大学附属第二医院诊治的455例下肢静脉曲张合并病理性穿通静脉功能不全患者(共497条患肢)。患者大隐静脉主干接受静脉腔内射频消融术,病理性穿通静脉接受彩色多普勒超声引导下套管针经皮穿刺电凝术,比较术前和术后3、12、24个月的静脉疾病临床严重程度评分(venous clinical severity score,VCSS)变化情况,记录术后复发和并发症发生情况。结果患者术后3、12、24个月的VCSS为(10.30±4.57)分、(4.52±2.00)分、(1.38±1.31)分,较术前的(16.09±6.63)分均持续下降,且与术前比较、术后3个月与术后12个月比较、术后3个月与术后24个月比较、术后12个月与术后24个月比较,差异均有统计学意义(P<0.001)。术后下肢溃疡患者的溃疡创面均完全愈合。4例患者出现足踝区行走时疼痛,症状均于2周内缓解消失。患者未发生深静脉血栓、血肿、隐神经损伤、动脉缺血或感染等并发症。结论静脉腔内热消融联合彩色多普勒超声引导下套管针经皮穿刺电凝术治疗病理性穿通静脉可显著改善下肢皮肤溃疡等慢性静脉功能不全症状,中期效果稳定且安全。Objective To evaluate the mid-term clinical efficacy and safety of endovenous thermal ablation combined with color Doppler ultrasound-guided percutaneous cannula needle electrocoagulation for pathological perforating veins in patients with chronic lower extremity venous insufficiency.Methods The clinical data of 455 patients(497 limbs)with varicose veins and pathological perforating veins treated at the Second Affiliated Hospital of Harbin Medical University from September 2017 to September 2023 were included retrospectively.The great saphenous vein trunk was treated with endovenous radiofrequency ablation,while pathological perforating veins were treated with ultrasound-guided percutaneous electrocoagulation using cannula needle.The venous clinical severity score(VCSS)was recorded and analyzed preoperatively and at 3,12,24 months postoperatively.Postoperative recurrence and complications were documented additionally.Results The VCSS scores of patients at 3,12,24 months postoperatively were(10.30±4.57)points,(4.52±2.00)points and(1.38±1.31)points,respectively,showing a continuous decline compared to the preoperative score of(16.09±6.63)points,with statistically significant differences(P<0.001).Additionally,statistically significant differences were observed in the comparisons between the VCSS at 3 months and 12 months,3 months and 24 months as well as 12 months and 24 months postoperatively(P<0.001).All patients with lower limb ulcers achieved complete ulcer healing.Four patients experienced ankle pain while walking,which resolved within two weeks.No cases of deep vein thrombosis,hematoma,saphenous nerve injury,arterial ischemia or infection were observed.Conclusion Endovenous thermal ablation combined with ultrasound-guided percutaneous electrocoagulation using cannula needle is an effective and safe treatment for pathological perforating veins in chronic venous insufficiency patients.It significantly improves symptoms such as lower limb skin ulcers,with stable mid-term outcomes and safety.

关 键 词：慢性静脉功能不全 病理性穿通静脉 静脉性溃疡 静脉曲张 

分 类 号：R654.4[医药卫生—外科学]