术前MRV联合多普勒超声在活动性下肢静脉性溃疡诊断及治疗中的作用

Preoperative assessment with MRV in patients with active venous ulcers of low extremities

目的探讨术前磁共振静脉造影(magnetic resonance venography,MRV)检查在活动性下肢静脉性溃疡诊断及治疗中的作用。方法回顾性分析60例慢性下肢静脉性溃疡患者资料,根据术前进行MRV联合多普勒超声检查(35例)和单纯多普勒超声检查(25例),分别设定为A组和B组。患者行腔内激光治疗技术(endovenous laser ablation,EVLT)联合隐股静脉结扎术,应用Kaplan-M eier生存分析方法对两组患者术后6个月的溃疡愈合率及术后36个月的溃疡复发率进行统计学分析。结果随访36个月,随访率93.33%。两组患者的性别、年龄、溃疡直径和溃疡持续时间差异无统计学意义。术后6个月,两组患者的累积溃疡愈合率差异没有统计学意义(88.6%vs 92%,P=0.642)。36个月的随访期中,A组累积溃疡复发率明显低于B组(5.7%vs 24%,P=0.037)。结论术前M RV联合多普勒超声检查对活动性下肢静脉性溃疡的诊断和治疗具有重要的指导价值。

Objective To evaluate the application and clinical value of preoperative assessment with magnetic resonance venography（ MRV） in the treatment of patients with active venous ulcers of low extremities. Methods Sixty patients with chronic venous ulcers of low extremities were divided into two groups： 35 patients underwent MRV and duplex ultrasound（ US） examination（ group A） and 25 patients underwent US examination alone（ group B） for preoperative evaluation. Patients were treated with endovenous laser ablation（ EVLA） and ligation of the saphenofemoral junction（ SFL） procedures.The ulcer healing rate at 6 months and ulcer recurrence rate at 36 months were analyzed with KaplanMeier method. Results Among 60 patients 56 were follow ed up for 36 months after the start of treatment. There was no statistical difference in gender,age,ulcer diameter and duration of ulcer between two groups. There was no significant difference in cumulative rate of ulcer healing at 6 months after operation between two groups（ 88. 6% vs 92%,P = 0. 642）. During 36 months of follow -up,patients in group A had a significantly low er cumulative ulcer recurrence rate（ 5. 7%） than those patients in group B（ 24%,P = 0. 037）. Conclusion Preoperative assessment with MRV plus duplex ultrasound（ US） provides effective guidance for diagnosis and treatment for patients with active venous leg ulcers.