2018 年第 1 期 第 13 卷

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

作者：薛少伟李岩密费翔李民马晓辉

英文作者：

单位：100853北京，解放军总医院超声诊断科（薛少伟、李岩密、费翔、李民），血管外科（马晓辉）

英文单位：

关键词：大隐静脉曲张；彩色多普勒血流成像；导管消融术

英文关键词：

• 摘要：

• 【摘要】目的    探讨彩色多普勒血流成像（CDFI）在大隐静脉曲张腔内射频导管消融术中的应用价值。方法    选择2015年1月至2016 年6月解放军总医院血管外科收治的82例大隐静脉曲张（89条）患者进行CDFI检查，并选择符合手术适应证的患者进行腔内射频导管消融术，术后采用CDFI进行复查，分析CDFI在腔内射频导管消融术前后的应用价值。结果    术前82例患者的89条曲线大隐静脉中，检出单纯曲张26条，伴有深静脉瓣膜功能不全63条（伴有股浅静脉瓣膜功能不全21条、腘静脉瓣膜功能不全25条、股浅静脉+腘静脉+小腿交通静脉瓣膜功能不全17条）；合并下肢深静脉血栓4条。乏氏试验观察下肢深静脉反流时间，股浅静脉（38条）的反流时间最长，反流速度最大，与隐股静脉（89条）、腘静脉（42条）、小腿交通静脉（17条）比较［（5.6±1.9）s比（3.7±1.6）、（3.3±1.3）、（2.3±0.8）s，（49±15）cm/s比（42±13）、（34±11）、（27±9）cm/s］，差异均有统计学意义（均P＜0.05）。选择单纯大隐静脉曲张、大隐静脉曲张合并Ⅱ级以内深静脉瓣功能不全的67例患者71条血管进行腔内射频导管消融术治疗。术后1周复查，可见患者大隐静脉管腔内径明显变小，CDFI显示血流充盈性尚好，但部分患者可见断续状血流信号，提示可能存在轻微血栓现象；术后1个月复查，大隐静脉主干均完全闭合，且所有患者的伤口均达到一级愈合的标准，患者患肢水肿、疼痛、酸胀、沉重感、静脉迂曲等症状均全部缓解或者消失,其中有2例患者出现下肢疼痛、麻木感，有1例患者出现条索状硬结。结论    CDFI在大隐静脉曲张患者术前评估中具有重要的意义，能够为筛选合适患者的治疗方式提供依据，术中能够发挥实时监测和引导作用，用于术后复查可以对患者治疗效果进行评估。

• Value of color Doppler flow imaging in endovenous radiofrequency catheter ablation of great saphenous varicosis vein

  Xue Shaowei, Li Yanmi, Fei Xiang, Li Min, Ma Xiaohui

  Department of Ultrasonography, Chinese PLA General Hospital, Beijing 100853, China（Xue SW, Li YM, Fei X, Li M）; Department of Vascular Surgery, Chinese PLA General Hospital, Beijing 100853, China（Ma XH）

  Corresponding author: Li Yanmi, Email: liymimeng@163.com

  【Abstract】Objective     To evaluate the value of color Doppler flow imaging（CDFI） in endovenous radiofrequency ablation of great saphenous varicosis vein. Methods    A total of 82 patients with great saphenous varicosis vein（89 veins） who had endovenous radiofrequency ablation from January 2015 to June 2016 in Chinese PLA General Hospital were enrolled. CDFI examination was performed before and after operation. Results    Twenty-six simple great saphenous varicose veins and 63 veins complicated by deep venous valve insufficiency, including 21 cases of superficial femoral vein valve insufficiency, 25 cases of popliteal vein valve insufficiency and 17 cases of superficial femoral vein＋popliteal vein＋calf perforating vein valve insufficiency were detected by CDFI before operation; 4 veins had deep venous thrombosis. Superficial femoral vein(38 veins) had the longest reflux time and the maximum reflux speed compared to saphenous femoral vein(89 veins), popliteal vein(42 veins) and perforating vein(17 veins)［（5.6±1.9）s vs （3.7±1.6）,（3.3±1.3）,（2.3±0.8）s; （49±15）cm/s vs （42±13）,（34±11）,（27±9）cm/s］（P＜0.05）. Sixty-seven patients with 71 simple great saphenous varicose veins or complicated with deep venous insufficiency within grade Ⅱ had endovenous radiofrequency ablation. One week after operation, inner lumen diameters of great saphenous veins significantly diminished; CDFI showed good blood filling but some intermittent blood signals indicating possible existence of slight thrombus. Re-examination 1 month after operation showed that main saphenous veins were fully closed; all wounds achieved grade Ⅰ healing; symptoms of edema, pain, soreness, expansion, heaviness and venous circuity were alleviated or eliminated. Two patients had pain and numbness of lower limb; 1 patient had funicular callosity. Conclusion    CDFI shows great significance in preoperative assessment, intraoperative real-time monitoring and postoperative re-examination in patients with great saphenous varicose vein.

   【Key words】Great saphenous varicose vein；Color Doppler ultrasonography；Catheter ablation