超声引导泡沫硬化联合手术对下肢静脉曲张疗效及患者血流动力学VCSS评分炎症状态的改善作用观察

Effect of ultrasound-guided foam sclerotherapy combined with surgery on varicose veins of lower extremities and improvement of hemodynamics,VCSS score and inflammatory state

目的探讨超声引导泡沫硬化联合手术对下肢静脉曲张疗效及患者血流动力学、静脉临床严重程度评分(VCSS评分)、炎症状态的改善作用。方法将2017年11月至2019年1月本院收治的114例下肢静脉曲张患者,根据治疗方案不同分成治疗组62例、对照组52例。对照组患者给予传统的大隐静脉高位结扎术联合剔剥术治疗,治疗组患者给予超声引导泡沫硬化联合腔内射频闭合术进行治疗,术后随访6个月。对比2组患者的治疗疗效、术后血流动力学、VCSS评分、炎症状态以及并发症比例。结果治疗组患者的治疗总有效率98%(61/62)高于对照组的87%(45/52),差异有统计学意义(P<0.05);2组患者术后12 h的血流动力学指标心率、血氧饱和度(SpO2)、平均动脉压(MAP)值对比,差异无统计学意义(P>0.05);相较于术前,术后6个月2组患者的VCSS评分均降低,且治疗组低于对照组,差异有统计学意义(P<0.05);相较于术前,术后6个月2组患者的血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、基质金属蛋白酶(MMP)-13表达均降低,且治疗组低于对照组,差异有统计学意义(P<0.05);相较于术前,术后6个月2组患者的血清谷胱甘肽过氧化物酶(GSH-Px)表达均增高,且治疗组高于对照组,差异有统计学意义(P<0.05);治疗组术后并发症总发生率3%(2/62)低于对照组的17%(9/52),差异有统计学意义(P<0.05)。结论超声引导泡沫硬化联合手术治疗下肢静脉曲张疗效确切,能减少血流动力学影响,改善下肢静脉症状和炎症状态,且并发症少,临床推广价值高。

Objective To investigate the effect of ultrasound-guided foam sclerotherapy combined with surgery on varicose veins of lower extremities and improvement of hemodynamics,venous clinical severity score(VCSS)and inflammatory status.Methods A total of 114 patients with varicose veins of lower extremities admitted to our hospital between November 2017 and January 2019 were included in the study.According to different treatment methods,all patients were divided into the study group(n=62)and the control group(n=52).The control group was given conventional high saphenous vein ligation combined with debridement,and the study group was treated with ultrasound-guided foam sclerotherapy combined with intracavitary radiofrequency closure.All patients were followed up for 6 months.The therapeutic efficacy,postoperative hemodynamics,VCSS score,inflammatory status,and proportion of complications were compared between the two groups.Results The total effective rate in the study group was higher than that in the control group[98%(61/62)vs(87%(45/52)],with statistically significant difference(P<0.05).There were no statistically significant differences in the levels of hemodynamic parameters,such as HR,SpO2 and MAP between the two groups at 12 h after the operation(all P>0.05).The VCSS score in the two groups decreased at 6 months after the operation compared with baseline,and the VCSS score in the study group was lower than that in the control group,with statistically significant difference(P<0.05).The serum levels of TNF-α,IL-6 and MMP-13 in the two groups decreased at 6 months after the operation compared with those at the baseline,and the levels in the study group were lower than those in the control group,with statistically significant differences(all P<0.05).The expression level of serum GSH-Px in the two groups increased at 6 months after the operation compared with baseline,and the expression level in the study group was higher than that in the control group,with statistically significant difference(P<0.05).The total incidence of postoperative complications in the study group was lower than that in the control group[3%(2/62)vs 17%(9/52)],with statistically significant difference(P<0.05).Conclusion Ultrasound-guided foam sclerotherapy combined with surgery is effective in the treatment of varicose veins of lower extremities.It may reduce hemodynamic effects,and improve venous symptoms and inflammatory state of the lower extremities with less complications,and therefore is worthwhile for widespread use in clinical practices.