腔内激光消融联合泡沫硬化剂同期治疗大隐静脉瓣膜功能不全的对照研究

Controlled study of endovenous laser ablation combined with foam sclerotherapy for the treatment of valvular insufficiency of great saphenous vein

目的观察激光腔内消融(EVLA)同期联合属支曲张静脉泡沫硬化剂(FS)治疗大隐静脉瓣膜功能不全的可行性、安全性及临床疗效。方法 2015年7月至2016年12月,本院收治289例(452条患肢)大隐静脉瓣膜功能不全患者,经知情同意采用两种治疗方式:同期EVLA(主干)联合FS(属支)治疗组(203条患肢);单纯EVLA组(249条患肢)。比较两组患者主干闭合情况、术后并发症、生活质量评分及术后曲张静脉残留等指标。结果联合组的术后曲张静脉残留率及残留数量显著低于EVLA组(P<0.05)。术后6个月联合组的生活质量改善程度显著优于EVLA组(P<0.05),而技术成功率无明显差别(P>0.05)。术后1个月联合组局部硬结、皮下淤血及静脉炎等并发症发生率显著高于EVLA组(P<0.05),但在6个月时无明显差别(P>0.05)。结论 EVLA联合同期属支FS治疗大隐静脉瓣膜功能不全是一种安全、可行、能极大减少曲张静脉残留且带来早期预后改善的治疗方式。

Objective To study the clinical safety, feasibility and effectiveness of endovenous laser ablation（EVLA） combined with foam sclerotherapy（FS） for patients with valvular insufficiency of great saphenous vein. Methods 289 patients（452 lower limbs） with valvular insufficiency of great saphenous vein were treated in our center from July 2015 to December 2016. Patients were fully informed about the operation and were divided into two groups, one group received a combination treatment of FS and EVLA（203 limbs）, while the other group only received EVLA（249 limbs）. Parameters of occlusion status of the trunk, quality of life,postoperative complications and residual varicose veins were compared between two groups. Results The combination group had a significantly lower frequency of residual varicosity and number of residual varicosities per leg（P〈0.05）. After 6-months ＇ follow-up, combination group exhibited a better quality of life improvement than EVLA group（ P〈0.05）, while there was no significantly difference at technical success rate. Compared to EVLA group, Combination group had significantly higher frequencies of local induration,ecchymosis and phlebitis at one month（P〈0.05）, but no significant difference at six months（P〈0.05）. Conclusion EVLA combined with FS for valvular insufficiency of great saphenous vein is a safe and feasible approach treatment, and has the potentials to reduce residual varicosities and make early-stage improvement for patients.