CHIVA策略治疗下肢静脉功能不全的疗效分析

Effect of CHIVA strategy on venous valvular insufficiency in lower extremity

目的探讨CHIVA(conservative and hemodynamic correction of venous insufficiency)策略治疗下肢静脉功能不全的手术方法及疗效。方法选取2018年8月-2019年3月188例在解放军总医院第一医学中心接受CHIVA策略治疗的下肢静脉功能不全患者;并与同期采用传统剥脱手术方式完成的226例患者进行疗效比较。结果两组患者围术期指标比较:CHIVA组平均手术时间明显短于传统手术组[(58.2±22.0)min vs(76.4±28.1)min,P=0.000];手术切口数量明显少于传统手术组(4.2±2.1 vs 7.1±3.0,P=0.000),但切口较大;术后平均住院时间明显短于传统组[(2.0±0.9)d vs(3.3±1.1)d,P=0.000]。此外,CHIVA组大隐静脉根部结扎165例(结扎比例为87.8%),明显少于传统手术组(226例,100.0%)(P=0.000),CHIVA组未结扎23例中反流消除试验阳性16例。CHIVA组与传统手术组随访率(59.6%vs 43.4%)、浅静脉血栓形成(1.6%vs 5.3%)、静脉新形成血流正向的较粗大穿支(22.3%vs 0)、切口疼痛及感觉异常(4.3%vs 8.8%)、静脉曲张消退(41.5%vs 35.4%)及再手术率(4.3%vs 0)等指标均差异均有统计学意义(P均<0.05)。结论CHIVA策略治疗下肢静脉功能不全能够保留大隐静脉主干,相较传统手术具有手术创伤小、住院时间短、术后恢复快及随访并发症发生率低等优势,但二次手术干预率高。

Objective To evaluate the effect of conservative hemodynamic cure for venous insufficiency(CHIVA)strategy in the treatment of venous valvular insufficiency.Methods From August 2018 to March 2019,188 cases with venous valvular insufficiency in lower extremity received surgery according to the CHIVA strategy,and the effect was compared with 226 patients receiving conventional surgery in the First Medical Center,Chinese PLA General Hospital.Results The average surgical time([58.2±22.0]min vs[76.4±28.1]min,P=0.000),and the number of incisions(but larger)([4.2±2.1]cm vs[7.1±3.0]cm,P=0.000)in the CHIVA group were less than those in the traditional surgical group.The average length of hospital stay after surgery was significantly shorter than that in the traditional surgical group([2.0±0.9]d vs[3.3±1.1]d,P=0.000).Moreover,the root of the great saphenous vein(SV)was ligated in 165 cases(87.8%)in the CHIVA group,less than that of the traditional surgical group(226,100.0%)(P=0.000);among the 23 unligated cases in the CHIVA group,16 cases had positive result in reflux elimination test.There were significant differences between the CHIVA group and the traditional surgcial group in the follow-up rate(59.6%vs 43.4%),the incidence of superficial vein thrombosis(1.6%vs 5.3%),the number of forming larger positive perforators in the main trunk(22.3%vs 0),skin pain or paresthesia(4.3%vs 8.8%),shrunken varicose veins(41.5%vs 35.4%),and the secondary surgery rate(4.3%vs 0)(P<0.05).Conclusion CHIVA strategy can preserve the saphenous vein.Compared with the traditional surgery,advantages of the CHIVA strategy include rarer surgical invasion,shorter hospital stay,quicker recovery and lower follow-up complication rates,but the secondary surgery rate is higher.