经皮穿通静脉闭合术治疗下肢静脉曲张合并穿通静脉功能不全36例分析

doi:10.3877/cma.j.issn.2095-5782.2021.04.002

目的

探究经皮穿通静脉闭合术治疗下肢静脉曲张合并穿通静脉功能不全（IPVs）患者的临床疗效。

方法

回顾分析2019年6月至2021年6月本中心收治的下肢静脉曲张合并IPVs的36例患者临床资料，所有患者均经影像学证实并接受经皮穿通静脉闭合治疗。术后1个月、3个月接受定期随访，分析其治疗效果、并发症及复发情况。

结果

36例患者共对47条患肢进行经皮穿通静脉闭合术，技术成功率100%。术后1个月及3个月的静脉临床严重程度评分及生活质量评分均较术前有所改善，部分患者在术后出现了疼痛、静脉炎、硬结及感觉异常等轻度并发症。术后随访3个月，未见有复发情况。

结论

对于合并有IPVs的静脉曲张患者，接受经皮穿通静脉闭合术可取得良好的临床效果。

关键词: 下肢静脉曲张, IPVs, 经皮穿通静脉闭合术

Objective

To evaluate the clinical effect of percutaneous ablation of perforator veins(PAPS) in patients with lower extremity varicose veins combined with incompetent perforator veins(IPVs).

Methods

Clinical data of 36 patients who were diagnosed as lower extremity varicose veins with IPVs manifested by imaging examination,and treated by PAPS were collected and reviewed retrospectively. Patients were followed up 1 month and 3 months after discharge to analyze the therapeutic effect, complications and recurrence.

Results

47 limbs were performed PAPS in 36 patients. The technical success rate was 100%. The venous clinical severity score (VCSS) and the chronic venous insufficiency questionnaire (CIVIQ) at 1 month and 3 months after surgery were improved compared with the pre-operation. Some patients experienced mild complications such as pain, phlebitis, scleroma and paresthesia after treatment. No recurrence was found in 3 months follow-up.

Conclusions

For patients with varicose vein combined with IPVs, the PAPS can achieve good clinical results.

Key words: Lower extremity varicose vein, Incompetent perforator veins, Percutaneous ablation of perforator veins

表1 患者基线资料

项目		±s或n（%）
性别
	男	18（50%）
	女	18（50%）
年龄（岁）		53.83 ± 10.45
病程（年）		13.75 ± 10.96
患肢
	双侧	11（30.56%）
	左侧	15（41.67%）
	右侧	10（27.77%）
穿通静脉解剖定位
	Dodd组穿通支	3（6.12%）
	Boyd组穿通支	1（2.04%）
	Cockett组穿通支	45（91.84%）
术前CEAP分级
	C2级	3（8.33%）
	C3级	4（11.12%）
	C4级	14（38.89%）
	C5级	12（33.33%）
	C6级	3（8.33%）
治疗方式
	腔内消融	23（63.89%）
	腔内电凝	13（36.11%）

表1 患者基线资料

项目		±s或n（%）
性别
	男	18（50%）
	女	18（50%）
年龄（岁）		53.83 ± 10.45
病程（年）		13.75 ± 10.96
患肢
	双侧	11（30.56%）
	左侧	15（41.67%）
	右侧	10（27.77%）
穿通静脉解剖定位
	Dodd组穿通支	3（6.12%）
	Boyd组穿通支	1（2.04%）
	Cockett组穿通支	45（91.84%）
术前CEAP分级
	C2级	3（8.33%）
	C3级	4（11.12%）
	C4级	14（38.89%）
	C5级	12（33.33%）
	C6级	3（8.33%）
治疗方式
	腔内消融	23（63.89%）
	腔内电凝	13（36.11%）

表2 患者术前、术后VCSS及CIVIQ比较

组别	VCSS			CIVIQ
组别	±s	t值	P值	±s	t值	P值
术前	10 ± 4.67	-	-	55.67 ± 7.73	-	-
术后1个月	7.64 ± 4.03	5.34	< 0.01	60.14 ± 6.95	-5.00	< 0.01
术后3个月	4.36 ± 2.24	9.67	< 0.01	64.92 ± 3.89	-10.217	< 0.01

表2 患者术前、术后VCSS及CIVIQ比较

组别	VCSS			CIVIQ
组别	±s	t值	P值	±s	t值	P值
术前	10 ± 4.67	-	-	55.67 ± 7.73	-	-
术后1个月	7.64 ± 4.03	5.34	< 0.01	60.14 ± 6.95	-5.00	< 0.01
术后3个月	4.36 ± 2.24	9.67	< 0.01	64.92 ± 3.89	-10.217	< 0.01

表3 腔内消融及腔内电凝治疗方式间术前术后VCSS及CIVIQ比较

组别	VCSS			CIVIQ
组别	术前	术后1个月	术后3个月	术前	术后1个月	术后3个月
腔内消融	10.78 ± 4.42	8.04 ± 3.76	4.61 ± 1.99	55.04 ± 8.75	59.7 ± 7.93	64.57 ± 4.28
腔内电凝	8.62 ± 4.96	6.92 ± 4.54	3.92 ± 2.66	56.77 ± 5.64	60.92 ± 4.94	65.54 ± 3.13
t值	1.353	0.797	0.877	-0.638	-0.504	-0.717
P值	0.185	0.431	0.386	0.528	0.618	0.479

表3 腔内消融及腔内电凝治疗方式间术前术后VCSS及CIVIQ比较

组别	VCSS			CIVIQ
组别	术前	术后1个月	术后3个月	术前	术后1个月	术后3个月
腔内消融	10.78 ± 4.42	8.04 ± 3.76	4.61 ± 1.99	55.04 ± 8.75	59.7 ± 7.93	64.57 ± 4.28
腔内电凝	8.62 ± 4.96	6.92 ± 4.54	3.92 ± 2.66	56.77 ± 5.64	60.92 ± 4.94	65.54 ± 3.13
t值	1.353	0.797	0.877	-0.638	-0.504	-0.717
P值	0.185	0.431	0.386	0.528	0.618	0.479

图1 患者女性，46岁，因下肢静脉曲张入院1A：术前CEAP 5级，VCSS 14分；1B：超声证实其合并Cockett IPVs；1C：术中超声引导下将射频消融针置于穿通静脉内进行消融治疗；1D：术后3个月复查，VCSS 3分。

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Percutaneous ablation of perforator veins in patients with lower extremity varicose veins combined with incompetent perforator veins: analysis of 36 cases

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Percutaneous ablation of perforator veins in patients with lower extremity varicose veins combined with incompetent perforator veins: analysis of 36 cases