非单纯大隐静脉功能不全的原发性下肢静脉曲张患者射频闭合联合硬化治疗术

Endovenous radiofrequency obliteration combined with sclerotherapy in patients with primary varicose veins of the lower extremity caused by non-simple great saphenous vein valve dysfunction

目的:探讨除因单纯大隐静脉瓣膜功能不全外,由其他浅静脉返流或大隐静脉返流合并其他静脉返流造成的下肢静脉曲张的特点及治疗体会。材料与方法:2018年5月—2019年5月接受超声引导下射频闭合联合曲张静脉局部剥脱、硬化治疗术的非单纯大隐静脉瓣膜功能不全的原发性下肢静脉曲张患者共61例、63条肢体,其中男42例,女19例,年龄23~78岁,平均(55.9±13.2)岁。统计其返流静脉种类、直径及CEAP分级。返流大隐静脉、小隐静脉、前副隐静脉及病理性穿支静脉均行射频治疗,皮下曲张浅静脉行泡沫硬化治疗。局部静脉曲张明显处行点状剥脱术。术后即刻穿医用循序减压弹力袜。结果:本组非单纯大隐静脉瓣膜功能不全造成下肢静脉曲张的类型有10种情况。非单纯大隐静脉瓣膜功能不全肢体发生重度下肢静脉曲张(C4~C6级)的比例为54.0%(34/63)。病理性穿支静脉位于小腿患者中重度静脉曲张的发生率最高(81.8%,27/33)。手术成功率100%。61例患者中随访44例,44条肢体,随访率72.1%。44条肢体静脉曲张完全消失15条,临床分级降级的肢体24条,有效率88.6%。结论:对于原发性下肢静脉曲张患者术前诊断过程中需要全面掌握下肢浅静脉血流动力学情况。对于非单纯大隐静脉功能不全的原发性下肢静脉曲张患者,射频闭合联合硬化治疗术是一种微创、安全、有效的治疗方法,其近期疗效满意。

Objective:To explore the characteristics and treatment of varicose veins of the lower extremities caused by other superficial or great saphenous venous regurgitation combined with other venous regurgitation,except for the valve insufficiency of the great saphenous vein.Materials and Methods:From May 2018 to May 2019,61 cases(63 limbs)of primary varicose veins of lower extremities caused by non simple saphenous vein valve dysfunction were treated by ultrasound-guided endovenous radiofrequency obliteration combined with varicose vein local exfoliation and sclerotherapy.There were 42 males and 19 females,aged 23~78 years,the average age was(55.9±13.2)years.The types,diameters and CEAP grades of reflux veins were analyzed.The great saphenous vein,small saphenous vein,anterior accessory saphenous vein and pathological perforator vein were all treated with radiofrequency.The superficial varicose veins were treated with foam sclerotherapy.Exfoliation of local varicose vein was performed.After the operation,the patients wore the medical sequential decompression elastic socks.Results:In this group,there were 10 types of varicose veins in the lower extremities caused by the non simple valve insufficiency of the great saphenous vein.The proportion of severe varicose veins(C4~C6)was 34/63,54.0%in the limbs with non simple great saphenous valve insufficiency.The highest incidence of severe varicose veins was 81.8%(27/33).The success rate of operation was 100%.Forty-four cases were followed up in 61 patients,with a follow-up rate of 72.1%.There were 15 limbs with varicose veins disappearance and 24 limbs with clinical grade degradation in 44 limbs.The effective rate was 88.6%.Conclusion:It is necessary to master the hemodynamics of the superficial veins of the lower extremities in the preoperative diagnosis of the patients with primary varicose veins of the lower extremities.Endovenous radiofrequency obliteration combined with sclerotherapy is a minimally invasive,safe and effective method for the treatment of primary varicose veins of the lower extremities caused by non simple great saphenous vein dysfunction.