Comparison of the efficacy of patients with lower extremity varicose veins treated by high ligation and stripping and radiofrequency ablation
王世材 1阎军 1田琴琴 2闫盛 2刘龙 1魏明 1王丽萍
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 1太原市中心医院心脏血管外科，太原 030001
2. 2山西医科大学第二医院血管外科，太原 030001
折叠
摘要
目的 比较不保留膝下大隐静脉的高位结扎剥脱术（HLS）和保留膝下大隐静脉的腔内射频消融术（RFA）治疗下肢静脉曲张的疗效及其对患者生活质量的影响。 方法 回顾性分析2018年5月至2020年4月山西医科大学第二医院和太原市中心医院收治的177例（217条患肢）下肢静脉曲张患者的临床资料，根据手术方式不同分为HLS组（n=90，112条患肢）和RFA组（n=87，105条患肢）。采用t检验和χ 2检验比较两组术后两年内复发率、术后并发症、静脉临床严重程度评分（VCSS）以及慢性静脉功能不全问卷评分（CIVIQ-14）等情况。 结果 RFA组的住院时间［（4.67±1.11）d 比（9.34±2.24）d，t=17.523，P<0.001］、手术时间［（57.74±8.36）min 比（121.46±40.55）min，t=14.361，P<0.001］及术中出血量［（11.90±3.07）ml 比（85.06±21.21）ml，t=32.378，P<0.001］均优于HLS组，差异具有统计学意义。在术后并发症方面，RFA组的肢体疼痛（8 比 18，χ2=4.121，P=0.042）和麻木（6 比 16，χ2=4.812，P=0.028）发生率低于HLS组，差异具有统计学意义；但深静脉血栓形成、血栓性静脉炎、皮下血肿、感染、皮肤硬结等发生率，两组差异无统计学意义（均P>0.05）。177 例患者均完成2年的随访。随访期间，HLS组复发2例，RFA组未见复发。两组患者术后3个月、1年及2年的VCSS评分［HLS组：（5.30±1.07）分、（1.97±1.29）分、（1.87±1.31）分；RFA组：（1.44±0.50）分、（1.11±0.69）分、（1.09±0.68）分］及 CIVIQ-14评分［HLS组：（57.32±5.79）分、（61.50±5.17）分、（62.78±4.61）分；RFA组：（65.15±2.69）分、（65.43±2.51）分、（65.72±2.33）分］均较术前［HLS组：（9.20±0.96）分；RFA组：（9.11±0.87）分］表现出持续改善，差异具有统计学意义［（1）VCSS评分：HLS组：t=49.313，48.239，47.867，均P<0.001；RFA组：t=77.739，72.145，71.596，均P<0.001；（2）CIVIQ-14评分：HLS组：t=-12.700，-17.599，-18.922，均P<0.001；RFA组：t=-26.412，-26.814，-27.974，均P<0.001］。相较于HLS组，RFA组患者术后3个月、1年及2年的VCSS评分更低（t=31.073，5.469，4.924，均P<0.001），CIVIQ-14 评分更高（t=11.594，-6.464，-5.394，均P<0.001），差异具有统计学意义。 结论 保留膝下大隐静脉主干的RFA和不保留膝下大隐静脉的HLS均有良好的治疗效果。与传统的HLS比较，RFA手术时间更短，术后恢复更快，并发症较低和随访期生活质量改善较高，患者满意度较高。 Objective To compare the efficacy and quality of life of patients with lower extremity varicose veins treated by high ligation and stripping (HLS) without preservation of the great saphenous vein and endovascular radiofrequency ablation (RFA) with preservation of the below-knee great saphenous vein. Methods The clinical data of 177 patients (217 affected limbs) with lower extremity varicose veins admitted to the Second Hospital of Shanxi Medical University and Taiyuan Central Hospital from May 2018 to April 2020 were retrospectively collected and analyzed. Among them, 90 patients (112 affected limbs) received HLS and 87 patients (105 affected limbs) received RFA. The recurrence rate within 2 years after surgery, postoperative complications, venous clinical severity score (VCSS) and Chronic Venous Insufficiency Questionnaire (CIVIQ-14) were compared between two groups using t and χ2 tests. Results The length of hospital stay, operation time and intraoperative blood loss in RFA group were significantly less than those in HLS group [(4.67±1.11) d vs (9.34±2.24) d, t=17.523, P<0.001 (57.74±8.36) minvs (121.46±40.55) min, t=14.361, P<0.001 (11.90±3.07) mlvs (85.06±21.21) ml, t=32.378, P<0.001]. In terms of postoperative complications, limb pain and numbness were less common in the RFA group than that in the HLS group, and the differences were startistically significant (8vs 18,χ2=4.121, P=0.042 6 vs 16, χ2=4.812, P=0.028). However, there was no significant difference in the incidence of deep vein thrombosis, thrombophlebitis, subcutaneous hematoma, infection, skin induration, and other complications between the two groups. A total of 177 patients completed the 2-year follow-up, of which 2 patients had recurrence in HLS group and no recurrence in the RFA group. The scores of VCSS (HLS group: 5.30±1.07, 1.97±1.29, 1.87±1.31, 9.20±0.96 RFA group: 1.44±0.50, 1.11±0.69, 1.09±0.68, 9.11±0.87) and CIVIQ-14 scores (HLS group: 57.32±5.79, 61.50±5.17, 62.78±4.61, 49.43±5.42 RFA group: 65.15±2.69, 65.43±2.51, 65.72±2.33, 48.82±4.87) in the two groups at 3 months, 1 year and 2 years after operation were significantly improved compared with those before operation [(1) VCSS: HLS group: t=49.313, 48.239, 47.867, all P<0.001 RFA group: t=77.739, 72.145, 71.596, allP<0.001 (2) CIVIQ-14: HLS group:t=-12.700, -17.599, -18.922, all P<0.001 RFA group:t=-26.412, -26.814, -27.974, all P<0.001]. Compared with HLS group, the VCSS score was lower (t=31.073, 5.469, 4.924, all P<0.001) and CIVIQ-14 score was higher (t=11.594, -6.464, -5.394, all P<0.001) in RFA group at 3 months, 1 year and 2 years after operation, and the differences were startistically significant. Conclusion RFA with the preservation of the below-knee great saphenous vein and HLS without the preservation of the below-knee great saphenous vein show good therapeutic effect. Compared with HLS, RFA has shorter operation time, faster postoperative recovery, fewer complications, and improved quality of life during the follow-up period, with higher patient satisfaction.
Abstract
Objective To compare the efficacy and quality of life of patients with lower extremity varicose veins treated by high ligation and stripping (HLS) without preservation of the great saphenous vein and endovascular radiofrequency ablation (RFA) with preservation of the below-knee great saphenous vein. Methods The clinical data of 177 patients (217 affected limbs) with lower extremity varicose veins admitted to the Second Hospital of Shanxi Medical University and Taiyuan Central Hospital from May 2018 to April 2020 were retrospectively collected and analyzed. Among them, 90 patients (112 affected limbs) received HLS and 87 patients (105 affected limbs) received RFA. The recurrence rate within 2 years after surgery, postoperative complications, venous clinical severity score (VCSS) and Chronic Venous Insufficiency Questionnaire (CIVIQ-14) were compared between two groups using t and χ2 tests. Results The length of hospital stay, operation time and intraoperative blood loss in RFA group were significantly less than those in HLS group [(4.67±1.11) d vs (9.34±2.24) d, t=17.523, P<0.001 (57.74±8.36) minvs (121.46±40.55) min, t=14.361, P<0.001 (11.90±3.07) mlvs (85.06±21.21) ml, t=32.378, P<0.001]. In terms of postoperative complications, limb pain and numbness were less common in the RFA group than that in the HLS group, and the differences were startistically significant (8vs 18,χ2=4.121, P=0.042 6 vs 16, χ2=4.812, P=0.028). However, there was no significant difference in the incidence of deep vein thrombosis, thrombophlebitis, subcutaneous hematoma, infection, skin induration, and other complications between the two groups. A total of 177 patients completed the 2-year follow-up, of which 2 patients had recurrence in HLS group and no recurrence in the RFA group. The scores of VCSS (HLS group: 5.30±1.07, 1.97±1.29, 1.87±1.31, 9.20±0.96 RFA group: 1.44±0.50, 1.11±0.69, 1.09±0.68, 9.11±0.87) and CIVIQ-14 scores (HLS group: 57.32±5.79, 61.50±5.17, 62.78±4.61, 49.43±5.42 RFA group: 65.15±2.69, 65.43±2.51, 65.72±2.33, 48.82±4.87) in the two groups at 3 months, 1 year and 2 years after operation were significantly improved compared with those before operation [(1) VCSS: HLS group: t=49.313, 48.239, 47.867, all P<0.001 RFA group: t=77.739, 72.145, 71.596, allP<0.001 (2) CIVIQ-14: HLS group:t=-12.700, -17.599, -18.922, all P<0.001 RFA group:t=-26.412, -26.814, -27.974, all P<0.001]. Compared with HLS group, the VCSS score was lower (t=31.073, 5.469, 4.924, all P<0.001) and CIVIQ-14 score was higher (t=11.594, -6.464, -5.394, all P<0.001) in RFA group at 3 months, 1 year and 2 years after operation, and the differences were startistically significant. Conclusion RFA with the preservation of the below-knee great saphenous vein and HLS without the preservation of the below-knee great saphenous vein show good therapeutic effect. Compared with HLS, RFA has shorter operation time, faster postoperative recovery, fewer complications, and improved quality of life during the follow-up period, with higher patient satisfaction.
关键词
大隐静脉曲张/射频消融术/高位结扎剥脱术/并发症/生活质量
Key words
Great saphenous varicose vein/Radiofrequency ablation/High ligation and stripping/Complications/Quality of life
万方数据