老年患者下肢静脉曲张的腔内射频消融术疗效及溃疡复发风险评估

doi:10.11958/20260219

摘要/Abstract

摘要：

目的探讨腔内射频消融术（RFA）治疗老年下肢静脉曲张患者的临床疗效，分析静脉性溃疡（VLU）复发的独立影响因素并建立预测列线图。方法回顾性分析2020年1月—2022年1月接受RFA治疗的211例老年下肢静脉曲张合并VLU患者的临床资料，记录手术相关指标、围手术期并发症及远期随访数据。采用单因素分析和多因素Logistic回归模型筛选溃疡复发的独立影响因素，基于独立影响因素构建复发风险预测列线图，并通过Bootstrap自助抽样法进行内部验证。结果所有患者手术成功率为100%；术后随访中静脉临床严重程度评分（VCSS）显著下降（P<0.01），围手术期并发症发生率为8.06%（17/211例）。211例患者中79例出现复发（复发组），其余132例纳入未复发组。单因素分析及多因素Logistic回归分析显示，年龄、体质量指数（BMI）、糖尿病史、溃疡面积、术后弹力袜使用依从性差及深静脉反流是老年患者VLU复发的独立影响因素（P<0.05）；基于上述影响因素构建的列线图预测C-index为0.832（95%CI：0.781~0.887），Bootstrap校正后C-index为0.814，校准曲线与理想曲线贴合度良好，决策曲线提示模型具有较高临床实用性。结论 RFA对老年下肢静脉曲张具有较好的临床疗效，年龄、BMI、糖尿病史、溃疡面积、术后弹力袜使用依从性差及深静脉反流是溃疡复发的影响因素。

关键词: 老年人, 射频消融术, 下肢静脉曲张, 下肢静脉性溃疡, 复发

Abstract:

Objective To investigate the clinical efficacy of endovenous radiofrequency ablation (RFA) in elderly patients with lower extremity varicose veins, and to analyze the independent risk factors for venous leg ulcer (VLU) recurrence and establish a predictive nomogram. Methods Clinical data of 211 elderly patients with lower extremity varicose veins complicated by venous leg ulcer (VLU) who underwent RFA from January 2020 to January 2022 were retrospectively analyzed. Operative parameters, perioperative complications and long-term follow-up data were recorded. Univariate analysis and multivariate Logistic regression models were used to screen independent risk factors for ulcer recurrence. A recurrence risk prediction nomogram was constructed based on the identified independent risk factors and internally validated using the Bootstrap resampling method. Results The technical success rate of the procedure was 100% for all patients. The venous clinical severity score (VCSS) showed a significant decrease during the postoperative follow-up (P<0.01). The perioperative complication rate was 8.06% (17/211). Among the 211 patients, 79 experienced recurrence (recurrence group), and the remaining 132 cases were included in the non-recurrence group. Univariate analysis and multivariate Logistic regression analysis revealed that age, body mass index (BMI), history of diabetes, ulcer area, poor compliance with compression stocking therapy postoperatively and deep venous reflux were independent risk factors for venous ulcer recurrence in elderly patients (P<0.05). The nomogram constructed based on these factors had a predictive C-index of 0.832 (95%CI: 0.781-0.887). The Bootstrap-corrected C-index was 0.814. The calibration curve showed good agreement with the ideal curve, and the decision curve analysis indicated high clinical utility of the model. Conclusion RFA treatment for elderly patients with lower limb varicose veins has the characteristics of minimal trauma, fast recovery, definite long-term efficacy and high safety. Age, BMI, history of diabetes, ulcer area, poor postoperative compression stocking compliance and deep venous reflux are key risk factors for ulcer recurrence.

Key words: aged, radiofrequency ablation, lower extremity varicose veins, venous leg ulcer, recurrence

中图分类号:

R543.1

图/表 5

参考文献 21

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组别		n		年龄/岁			性别（男/女）		BMI/（kg/m²）				病程/年
未复发组		132		68.61±4.99			58/74		24.61±2.82				7.93±2.21
复发组		79		71.81±4.89			45/34		26.69±3.06				8.56±2.85
t或χ²				4.543^＊＊			3.354		5.019^＊＊				1.793
组别	吸烟				饮酒			高血压		糖尿病史		冠心病史
未复发组	37（28.03）				24（18.18）			49（37.12）		41（31.06）		33（25.00）
复发组	29（36.71）				22（27.85）			36（45.57）		38（48.10）		29（36.71）
t或χ²	1.732				2.709			1.466		6.127^＊		3.265
组别			溃疡面积/cm²			术后弹力袜使用依从性差					深静脉反流
未复发组			5.29±2.52			28（21.21）					67（50.76）
复发组			8.75±3.13			36（45.57）					57（72.15）
t或χ²			8.792^＊＊			13.876^＊＊					9.336^＊＊

组别		n		年龄/岁			性别（男/女）		BMI/（kg/m²）				病程/年
未复发组		132		68.61±4.99			58/74		24.61±2.82				7.93±2.21
复发组		79		71.81±4.89			45/34		26.69±3.06				8.56±2.85
t或χ²				4.543^＊＊			3.354		5.019^＊＊				1.793
组别	吸烟				饮酒			高血压		糖尿病史		冠心病史
未复发组	37（28.03）				24（18.18）			49（37.12）		41（31.06）		33（25.00）
复发组	29（36.71）				22（27.85）			36（45.57）		38（48.10）		29（36.71）
t或χ²	1.732				2.709			1.466		6.127^＊		3.265
组别			溃疡面积/cm²			术后弹力袜使用依从性差					深静脉反流
未复发组			5.29±2.52			28（21.21）					67（50.76）
复发组			8.75±3.13			36（45.57）					57（72.15）
t或χ²			8.792^＊＊			13.876^＊＊					9.336^＊＊

因素	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.140	0.045	9.679	0.002	1.150（1.053~1.256）
深静脉反流	0.215	0.071	9.170	0.002	1.240（1.079~1.425）
糖尿病史	0.293	0.091	10.367	0.001	1.340（1.121~1.602）
BMI	0.341	0.075	10.326	0.001	1.273（1.099~1.474）
溃疡面积	0.118	0.057	4.286	0.038	1.125（1.006~1.258）
术后弹力袜使用依从性	0.137	0.069	3.942	0.047	1.147（1.002~1.313）
常数项	-3.852	0.521	54.470	<0.001	<0.001

因素	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.140	0.045	9.679	0.002	1.150（1.053~1.256）
深静脉反流	0.215	0.071	9.170	0.002	1.240（1.079~1.425）
糖尿病史	0.293	0.091	10.367	0.001	1.340（1.121~1.602）
BMI	0.341	0.075	10.326	0.001	1.273（1.099~1.474）
溃疡面积	0.118	0.057	4.286	0.038	1.125（1.006~1.258）
术后弹力袜使用依从性	0.137	0.069	3.942	0.047	1.147（1.002~1.313）
常数项	-3.852	0.521	54.470	<0.001	<0.001