| Objective:To explore the efficacy of the ultrasound-guided foam sclerosing agent in treating under the knee perforating vein of early(C2,C3)primary varicose great saphenous vein with foam sclerosing agent,analyze the risk factors of postoperative under the knee perforating vein reflux,develop and internally verify the nomogram of individualized prediction of under the knee perforating vein reflux,and provide guidance for clinical screening of high-risk groups of postoperative under the knee perforating vein reflux for implementing intervention and treatment earlier,so as to reduce the clinical problems caused by postoperative under the knee perforating vein reflux.Methods:A retrospective analysis was performed on the patients who received the traditional surgical ligature treatment of perforating vein and perforating vein hardening with foam sclerosing agent under ultrasound guidance in our hospital from January 2018 to December 2021.According to relevant literature,the parameters of adverse events after the two surgeries mentioned above were 0.13 and 0.37,and the minimum sample size was calculated with PASS15 software by taking 0.05 forα,and 0.9 for 1-β.According to the calculation,64 samples should be taken from each group,but actually 72samples were taken from each group considering 10%loss rate,and the total was 144 samples.A total of 144 patients(72 cases in each group)were included in the study,and the clinical data were fully returned for 12 months.T-test was adopted to analyze the amount of intraoperative bleeding and the number of incisions.Chi-square test was adopted to analyze the incidence of wound infection,recurrence,nerve injury and postoperative perforating vein reflux.Rank sum test was adopted to analyze the time of hospitalization and VAS score of each postoperative period.R4.2.1 was adopted to make the risk nomogram of reflux.We developed a prediction model based on the training data set of 144 postoperative patients,collected the index results of age,gender,CEAP grade,BMI,whether the perforating veins use of foam sclerosing agent,number of births,family history and postoperative elastic socks compliance were in all cases,implemented single factor and multiple factors analysis on the indexes mentioned above,screened the independent risk factors of postoperative perforating vein reflux with logistic regression,established corresponding nomogram model in R software according to the results of logistic regression,analyzed the prediction value of model to postoperative genu perforating vein reflux by making ROC curve,implemented internal verification to the established corresponding nomogram model with bootstrap method,and then further evaluated the distinguishing ability and calibration of model.Results:1.The average of intraoperative bleeding in the ligature treatment group was(14.58±2.04)ml,and that in the foam sclerosing agent treatment group was(9.03±1.93)ml.The average of incisions in the ligature treatment group was(9.06±1.80),and that in the foam sclerosing agent treatment group was(4.97±1.64).According to statistical tests,statistical differences existed in the two groups(P<0.05).2.The incidence of nerve injury in the ligature treatment group was8.3%and that in the foam sclerosing agent treatment group was 5.6%.The incidence of incision infection in the ligature treatment group was 9.7%,and that in the foam sclerosing agent treatment group was 6.9%.According to statistical tests,no statistical differences existed in the two groups(P>0.05).3.The VAS score of ligature treatment group 2 hours after operation was 1(1,2),and that of foam sclerosing agent treatment group 2 hours after operation was 1(1,1).The VAS score of ligature treatment group 6 hours after operation was 4(4,5),and that of foam sclerosing agent treatment group6 hours after operation was 3(2,3).The VAS score of ligature treatment group 12 hours after operation was 3(3,3.75),and that of foam sclerosing agent treatment group 12 hours after operation was 2(1.25,2).The VAS score of ligature treatment group 24 hours after operation was 2(1.25,2),and that of foam sclerosing agent treatment group 24 hours after operation was 1(1,1).According to statistical tests,statistical differences existed in the two groups(P<0.05).4.The incidence of postoperative perforating vein reflux was 11.1%in the ligature treatment group,and that was 15.3%in the foam sclerosing agent treatment group.The recurrence rate of the foam sclerosing agent treatment group was 8.3%,and that of the ligature treatment group was 6.9%.According to statistical tests,no statistical differences existed in the two groups(P>0.05).5.The length of stay in the ligature treatment group was 4(4,4)days and that in the foam sclerosing agent treatment group was 3(3,3)days.According to statistical tests,statistical differences existed(P<0.05).6.The AUC areas under the curve of CEAP grade,BMI,age,elastic socks compliance and family history were 0.778,0.773,0.673,0.716 and0.743 respectively,which all hadstatistical significance(P<0.05).7.According to multivariate logistic regression analysis,CEAP grade was(OR=26.151,95%CI:3.079～222.137),BMI was(OR=3.105,95%CI:1.318～7.308),age was(OR=5.692,95%CI:1.261～25.690)and elastic socks compliance was(OR=4.927,95%CI:1.319～18.405),which were all independent risk factors for postoperative perforating vein reflux(P<0.05).8.The sensitivity and specificity of the established nomogram model were 83.3%and 87.06%respectively.The AUC of the model was 0.887(95%CI:0.783～0.992),the C-inde of its validation set was 0.844(95%CI:0.623～1.00),and both of the differences had statistical significance(P<0.05).9.According to the results of Homsmer-Lemeshow test,the?~2value of the model was 8.809,and its corresponding P value was 0.358>0.05,indicating that the model ownedgood calibration ability,showed good fit between the calibration curve made in the validation set and the reference line,and demonstrated that the nomogram prediction model hadgood differentiation and consistency.Conclusions:1.In the treatment of under the knee perforating vein of early primary varicose great saphenous vein,adopting foam sclerosing agent under ultrasound guidance can reduce trauma,and achieve the efficacy is close to that of incision ligature treatment.2.The risk nomogram of perforating vein reflux combined CEAP classification,BMI,age and elastic stockings compliance,which can be conveniently adopted to predict the risk of postoperative under the knee perforating vein reflux after undergoing surgical ligature treatment of perforating vein and treatment of perforating vein with foam sclerosing agent under ultrasound guidance. |
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