反流性穿支静脉的射频治疗对静脉溃疡愈合的意义

Value of radiofrequency ablation for perforating venous reflux

目的比较射频闭合导管与泡沫硬化剂处理反流性穿支静脉治疗静脉性溃疡的疗效.方法对北京协和医院2018年1~12月间56例静脉性溃疡(C5/6)病例(56条肢体),分别采用射频闭合导管(A组,30例)与泡沫硬化剂(B组,26例)闭合反流穿支静脉,随访1~12个月,观察溃疡愈合情况,超声观察穿支静脉闭合情况,并行疗效分析.结果即刻手术成功率100%.随访期内A组与B组溃疡复发为1例和4例,穿支静脉再通为2例和6例.12个月A组和B组免于溃疡复发率分别为92.6%±5.1%、82.7%±8.0%,免于穿支静脉再通发生率分别为88.4%±6.3%、61.5%±11.2%.单因素分析提示最终不良事件与手术方法和穿支直径有显著相关性:A组优于B组(P=0.016),穿支直径<3.5 mm优于≥3.5 mm(P=0.048).多因素回归分析发现手术方法是最终不良结果的唯一危险因素(P=0.040).结论射频闭合导管处理反流性穿支静脉治疗静脉性溃疡与硬化剂注射治疗相比中期穿支静脉再通率和溃疡复发较低.

Objective To assess the value of radiofrequency ablation versus sclerotherapy for perforating venous refux in the treatment of venous ulceration.Methods This study included 56 patients with venous ulceration(C5/C6,56 limbs)treated at Peking Union Medical College Hospital in 2018.The patients underwent radiofrequency ablation(Group A,30 patients)or sclerotherapy(Group B,26 patients)of perforating venous reflux.Results The immediate success rate was 100%.During 1 to 12-month fllow-up,5 patients(1 in Group A and 4 in Group B)had recurrent venous ulcers.Recanalization of perforating veins was found in 8 patients(2 in Group A and 6 in Group B).The rates of free from venous ulcer's.recurrence in Group A and Group B were 92.6%±5.1%and 82.7%±8.0%,respectively.The rates of free from perforating vein recanalization were 88.4%+6.3%and 61.5%±11.2%in Group A and Group.B respectively.Univariate analysis of postoperative venous recanalization and ulceration recurrence revealed significant correlation between operation methods,perforating vein diameter and occurrence of adverse events.Specifically,radiofrequeney ablation is associated with better outcome than sclerotherapy(P=0.016),and perforating veins with diameter less than 3.5mm is associated with better outcome than those with diameter≥3.5mm(P=0.048).By multivariate regression analysis,operation type was the only risk factor of poor prognosis(P=0.040).Conclusion Radiofrequency ablation of perforating veins resuted in reduced rates of mid-term recanalization and ulceration recurrence compared with ultrasound-guided sclerotherapy.