大隐静脉曲张术后复发因素的随访初析

Preliminary analysis for the recurrence of comparing open surgery,endovenous ablation for great saphenous varicose veins

目的调查大隐静脉曲张术后复发因素及可能原因。方法通过检索2000年1月至2020年5月的PubMed、万方数据和中国知网数据库,收集腔内激光消融(EVLA)、射频消融(RFA)和大隐静脉(GSV)高位结扎剥脱术(HLA)的术后复发的随机对照研究(RCT)文献,采用临床和彩色多普勒超声检查评估,记录复发静脉返流的解剖部位、返流的可能原因和复发的症状性静脉曲张(VVs)的处理。结果共有9项关于EVA与HLS的RCT文献纳入分析中。在1765条下肢中712条下肢执行HLS手术,354条下肢接受RFA治疗,699条接受EVLA治疗,平均年龄47岁,平均随访3.4年,女性患者占比达77%,轻度GSV曲张(C2-3疾病)接近90%。在所有研究中,大腿段和小腿段是最常见的复发的解剖部位,复发原因包括新生血管、静脉再通、副隐静脉存在、穿支形成、手术技术问题。复发率统计各组的差异较大,RFA:2年随访(一个组)的总复发为(20.5%),3年(二个组)分别为53.3%和17.1%,5年(一个组)为12.9%。HLS:2年随访(三个组)的总复发分别为16.7%、3.0%和17.5%,3年(二个组)分别为23.1%和21.1%,5年(三个组)为42.6%、26.8%和4.2%。EVLA:2年随访(二个组)的总复发为17.0%和28.6%,3年(一个组)为28.6%,5年(三个组)分别为47.8%、29.6%和5.6%。结论文献报告GSV曲张手术后复发的部位和原因基本一致,但在复发率在各文献中的差异较大,EVLA、RFA、HLA三种方法均有较高的复发率。

Objective To investigate the factors and possible causes of recurrence for great saphe⁃nous varicose veins after operation.Methods PubMed,Wanfang data and CNKI database from January 2000 to May 2020 were researched,collecting randomized controlled study(RCT)literature on endove⁃nous laser ablation(EVLA),radio frequency ablation(RFA)and high ligation and stripping of GSV(HLS)about postoperative recurrence,using clinical and color Doppler ultrasonography to evaluate the anatomical location of recurrent venous reflux,possible causes of reflux,and recurrent symptomatic varicose veins(VVs)processing.Results Nine RCT documents on EVLA and HLS were included in the analysis.Among the 1765 lower extremities,712 lower extremities underwent HLS surgery,354 received RFA treatment,and 699 received EVLA treatment.The average age was 47 years,and the average follow⁃up was 3.4 years.The ratio of female patients reached 77%,with mild GSV varicose(C2⁃C3)close to 90%.In all RCTs,the thigh and calf are the most common anatomical sites for recurrence.The causes of recurrence include neovascularization,venous recanalization,presence of accessory saphenous vein,perforator formation,and surgical failure.The recurrence rate statistics varied greatly between groups.RFA:The total recurrence in the 2⁃year follow⁃up(one group)was 20.5%)the 3⁃year(two groups)were 53.3%and 17.1%,and the 5⁃year(one group)was 12.9%.HLS:The total recurrences in the 2⁃year follow⁃up(three groups)were 16.7%,3.0%,and 17.5%,respectively,the 3⁃year(two groups)were 23.1%and 21.1%,and the 5⁃year(three groups)were 42.6%,26.8%and 4.2%.EVLA:The total recurrences in the 2⁃year follow⁃up(two groups)were 17.0%and 28.6%,the 3⁃year(one group)was 28.6%,and the 5⁃year(three groups)were 47.8%,29.6%,and 5.6%,respectively.Conclusion The literature reports that the location and cause of recurrence after GSV varicose surgery are basically the same,but the recurrence rate varies greatly in the literature.The three methods of EVLA,RFA,and HLA have higher recurrence rates.