Gender differences in endovenous radio-frequency ablation of great saphenous varicosis vein and application of color doppler flow imaging
-
摘要:
目的探讨大隐静脉主干射频消融治疗中的性别差异及彩色多普勒血管成像（CDFI）应用体会。 方法2018年3月1日~2019年6月1日武汉某三甲医院血管外科收治72例大隐静脉曲张患者，其中70例大隐静脉曲张（94条）患者进行围手术期CDFI评估，并局麻下实施进行大隐静脉主干射频消融治疗，分析大隐静脉射频消融治疗中CDFI的重要性及应用体会。 结果72例就诊患者中70例顺利完成彩超引导下的大隐静脉射频消融，且术后均顺利出院，虽然未加行大隐静脉高位结扎，围手术期未发生深静脉血栓、肺栓塞等严重并发症；术后1月复查，大隐静脉主干均完全闭合。患者患肢不适症状（如水肿、疼痛、酸胀、沉重感、麻木等）均明显缓解或消失。男性/女性病人在年龄、手术部位、CEAP分级、大隐静脉主干返流时间、大隐静脉主干返流速度的差异均无统计学意义（P>0.05）；在大隐静脉主干内径比较上，男性/女性病人在左下肢的差异无统计学意义（P>0.05），而在右下肢大隐静脉内径的差异存在统计学意义（P<0.05）。 结论CDFI在大隐静脉曲张患者围手术期评估具有重要的作用，术前明确病变及手术方案选择、射频术中发挥引导作用，术后复查评估综合治疗效果。无高位结扎的大隐静脉射频消融术具有满意的短期效果，无严重并发症；女性病人右下肢大隐静脉内径明显小于男性病人右下肢大隐静脉内径。 Abstract:ObjectiveTo explore the gender differences in endovenous radio-frequency ablation(RFA) of great saphenous varicosis vein (GSVV) and evaluate the application ande experience of color Doppler flow imaging(CDFI). MethodsWe included 72 patients with GSVV (96 extremities) in vascular surgery department, and 70 patients (94 extrenities) underwent endovenous RFA from March 2018 to June 2019, in a third-class hospital of Wuhan. CDFI examination was performed before, during and after operation. Then results were analyzed to assess the importance and experience of the CDFI. ResultsAmong 72 patients with GSVV, 70 patients were performed to endovenous RFA for GSVV without high ligation and they all received satisfactory recover after the operation with none suffering from severe complications such as deep venous thrombosis or pulmonary embolism.One month after surgery, all of GSVV following RFA were reviewed. Symptoms of affected extremities such as edema,pain,local acid bilges and numbness were obviously relieved or disappeared.No significant difference was observed in age,surgical extremity, grade of CEAP, time and velocity of reflux of affected extremities between male and female groups (P>0.05).The difference of the diameter of left GSVV between two groups was not significant (P>0.05). The difference in the diameter of right GSVV between two groups was significant (P<0.05). ConclusionCDFI can figure out whether a patient suffers from GSVV and help to choose the optimal treatment.It also guides the ongoing operation during the intraoperative time and assesses therapeutic effect after operation.Short-term effect of endovenous RFA without high ligation of GSVV is satisfactory,with none encountering sever complications.The diameter of right GSVV of female patients is narrower than that of male patients. -
图 2 大隐静脉射频消融手术
A：患者手术床边站立位曲张血管定位；B：术中彩超引导下植入射频消融导管；C：麻醉肿胀液注射满意后“牛眼征”；D：测量射频导管头端距离股隐点距离
Figure 2. Radiofrequency ablation of great saphenous vein
表 1 患者一般临床资料
Table 1. General clinical data of patients
指标 男性（n=37） 女性（n=35） t/χ2 P 年龄（岁，Mean±SD） 65.6±10.3 62.9±12.1 1.023 0.310 手术部位（n） 右下肢 12 11 1.656 0.437 左下肢 15 10 双下肢 10 14 CEAP分级（n） C2 9 14 2.183 0.702 C3 6 5 C4 20 14 C5 1 1 C6 1 1 大隐静脉主干内径（cm，Mean±SD） 左下肢 0.83±0.24 0.76±0.33 0.814 0.420 右下肢 0.97±0.35 0.76±0.23 2.323 0.025 大隐静脉主干返流时间（s，Mean±SD）* 左下肢 4.42±2.83 3.70±2.46 0.965 0.340 右下肢 4.56±2.85 4.02±2.65 0.689 0.495 大隐静脉主干返流速度（cm/s，Mean±SD） 左下肢 48.78±39.22 83.57±73.78 1.220 0.245 右下肢 52.74±32.34 88.21±65.88 1.382 0.197 *距离股隐点2 cm处测量. 
下载: 导出CSV
-
[1] 靳 静. 彩色多普勒超声对下肢深静脉血栓形成的诊断价值[J]. 中国医药, 2016, 11(4): 594-7. doi: 10.3760/cma.j.issn.1673-4777.2016.04.034 [2] 孙 林, 杨 牟, 张居文. 手术治疗大隐静脉曲张并小腿局部溃疡25例的临床分析[J]. 中国临床医生, 2014, 42(6): 77-8. [3] 李国剑, 杨 镛, 杨国凯, 等. 下肢静脉曲张微创核心技术的最佳优选与临床应用[J]. 中国老年学杂志, 2016, 36(7): 1713-4. doi: 10.3969/j.issn.1005-9202.2016.07.081 [4] 薛少伟, 李岩密, 费 翔, 等. 彩色多普勒血流成像在大隐静脉曲张腔内射频导管消融术中的应用价值[J]. 中国医药, 2018, 13(1): 116-9. doi: 10.3760/cma.j.issn.1673-4777.2018.01.031 [5] Lagergren ER, Kempe K, Craven TE, et al. Gender-specific differences in great saphenous vein conduit. a link to lower extremity bypass outcomes disparities[J]. Ann Vasc Surg, 2017, 38(1): 36-41. [6] Sleilaty G, Maoula A, Hachem K, et al. Variations des diamètres segmentaires des veines saphènes internes chez une population coronaire tritronculaire[J]. Ann Cardiol Angeiol (Paris), 2007, 56(5): 241-6. doi: 10.1016/j.ancard.2007.05.002 [7] Fiebig A, Krusche P, Wolf A, et al. Heritability of chronic venous disease[J]. Hum Genet, 2010, 127(6): 669-74. doi: 10.1007/s00439-010-0812-9 [8] Obi AT, Reames BN, Rook TJ, et al. Outcomes associated with ablation compared to combined ablation and transilluminated powered phlebectomy in the treatment of venous varicosities[J]. Phlebology, 2016, 31(9): 618-24. doi: 10.1177/0268355515604257 [9] 路来社. 改良大隐静脉高位结扎剥脱术疗效分析[J]. 延安大学学报(医学科学版), 2017, 15(3): 31-2, 39. [10] 姜海军, 张 弘, 杨 植, 等. 不同微创方式治疗下肢静脉曲张的临床疗效比较[J]. 吉林大学学报:医学版, 2018, 44(2): 383-7. [11] 李 念, 刘 强, 石建军. 大隐静脉曲张治疗的研究进展[J]. 中国临床新医学, 2017, 10(3): 294-7. doi: 10.3969/j.issn.1674-3806.2017.03.32 [12] 朱晓铭, 李 亮, 唐晓勇, 等. 射频闭合术治疗大隐静脉曲张的临床观察[J]. 甘肃医药, 2018, 37(4): 333-4. [13] Woo HY, Kim SM, Kim D, et al. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein[J]. Ann Surg Treat Res, 2019, 96(6): 313-8. doi: 10.4174/astr.2019.96.6.313 [14] Kemaloğlu C. Saphenous vein diameter is a single risk factor for early recanalization after endothermal ablation of incompetent great saphenous vein[J]. Vascular, 2019, 27(5): 537-41. doi: 10.1177/1708538119837110 [15] Westin GG, Cayne NS, Lee V, et al. Radiofrequency and laser vein ablation for patients receiving warfarin anticoagulation is safe, effective, and durable[J]. J Vasc Surg Venous Lymphat Disord, 2020, 333(19): 30630-4. [16] Rai A, Porsalman M, Khatony A, et al. Comparison of foam sclerotherapy versus radiofrequency ablation in the treatment of primary varicose veins due to incompetent great saphenous vein: randomized clinical trial[J]. J Vasc Nurs, 2019, 37(4): 226-31. doi: 10.1016/j.jvn.2019.10.002 [17] Balint R, Farics A, Parti K, et al. Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein[J]. Review Vascular, 2016, 24(6): 649-57. doi: 10.1177/1708538116648035 [18] Izzo L, Pugliese F, Pieretti G, et al. High ligation of sapheno-femoral junction and thermal ablation for lower limb primary varicosity in day hospital setting[J]. Ann Ital Chir, 2019, 31(8): 264-75. [19] Sanioglu S, Yerebakan H, Farsak MB. Effects of two current great saphenous vein thermal ablation methods on visual analog scale and quality of life[J]. Biomed Res Int, 2017, 20(13): 8532149-60. [20] Sermsathanasawadi N, Jieamprasertbun J, Pruekprasert K, et al. Factors that influence venous leg ulcer healing and recurrence rate after endovenous radiofrequency ablation of incompetent saphenous vein[J]. J Vasc Surg Venous Lymphat Disord, 2019, 333(19): 30592-603. [21] Ekin EE, Kurtul Yildiz H. The importance of great saphenous vein types and segmental aplasia in venous reflux[J]. J Clin Ultrasound, 2017, 45(6): 332-6. doi: 10.1002/jcu.22457 [22] Seidel AC, Cavalari PJ, Rossi RM, et al. Proposal for classification of the great saphenous vein aplasia by the B-mode ultrasound[J]. Ann Vasc Surg, 2016, 31(3): 170-8. [23] Tauraginskii RA, Simakov S, Borsuk D, et al. The immediate effect of physical activity on ultrasound-derived venous reflux parameters[J]. J Vasc Surg Venous Lymphat Disord, 2019, 333(19): 30603-11. [24] Schul MW, Schloerke B, Gomes GM. The refluxing anterior accessory saphenous vein demonstrates similar clinical severity when compared to the refluxing great saphenous vein[J]. Phlebology, 2016, 31(9): 654-9. doi: 10.1177/0268355515604532 [25] Kim SM, Jung IM, Chung JK. Improvements of deep vein reflux following radiofrequency ablation for saphenous vein incompetence[J]. Phlebology, 2017, 32(1): 55-60. doi: 10.1177/0268355516629867 [26] 中华医学会外科学分会血管外科学组. 慢性下肢静脉疾病诊断与治 疗中国专家共识[J]. 中国血管外科杂志:电子版, 2014, 6(3): 143-51. -
点击查看大图
图(2) / 表(1)
计量
- 文章访问数: 783
- HTML全文浏览量: 382
- PDF下载量: 8
- 被引次数: 0
