保留静脉的下肢血流动力学纠正手术与传统静脉剥脱术治疗下肢静脉曲张的倾向性评分匹配对比研究

Comparison study on propensity score matching between conservative hemodynamic cure for venous insufficiency and traditional vein stripping in the treatment of lower extremity varicose veins

目的利用倾向性评分匹配法保留静脉的下肢血流动力学纠正手术(CHIVA)与传统静脉剥脱术治疗下肢静脉曲张的混杂因素,评价两种治疗的临床疗效。方法选取2020年5月至2020年8月河北医科大学第二医院收治的行手术治疗的下肢静脉曲张患者临床资料。根据手术方式不同分为CHIVA组(n=23)和对照组(n=83)。采用Logistic回归公式进行倾向性匹配评分,对照组83例患者中选取23例与CHIVA组匹配。统计并比较两组患者的手术及住院时间、术后不良反应;术后3个月对两组患者进行随访,观察并比较静脉曲张消退率、新发静脉曲张率、C4级患肢色素沉着减退率和生活质量静脉症状调查问卷(HASTI)评分。结果CHIVA组患者手术和住院时间均短于对照组(P<0.05);两组患者疼痛发生率比较,差异无统计学意义(P>0.05)。术后3个月,CHIVA组1例患者原有下肢静脉曲张未完全消退;两组患者均无新发静脉曲张;两组患者C4级患肢色素沉着减退率及生活质量HASTI评分比较,差异无统计学意义(P>0.05)。结论CHIVA手术安全、有效,可成为下肢静脉曲张患者的个体化治疗选择。

Objective To employ propensity score matching(PSM)method to balance the confounding factors of conservative hemodynamic cure for venous insufficiency(CHIVA)and traditional vein stripping for the treatment of lower extremity varicose veins and estimate their clinical efficacy.Method The clinical data of patients with varicose veins of lower limbs admitted to the Second Hospital of Hebei Medical University from May 2020 to August 2020 were collected.The subjects were divided into the CHIVA group(n=23)and control group(n=83)according to different surgical methods.PSM was calculated using Logistic regression,and 23 of 83 patients in the control group were selected to match the CHIVA group.The operation time and hospital stay of the two groups were recorded and compared.Other items,including the adverse events,the rate of varicose vein regression,new varicose veins appearance,and the rate of hypopigmentation of C4 grade limbs and the quality of life based on heaviness achiness swelling throbbing itching(HASTI)score during 3-month follow-up were also documented and compared between the two groups of patients.Result The operation and hospital stay of the CHIVA group were shorter than those of the control group(P<0.05);there was no significant difference in the incidence of pain between the two groups(P>0.05).Three months after the operation,the original varicose veins of the lower limb of 1 patient in the CHIVA group did not present complete relief;no new varicose veins were observed in both groups;there was no significant difference in the rate of hypopigmentation of C4 grade limbs and HASTI score between the two groups(P>0.05).Conclusion CHIVA is safe and effective,and can become one of the individualized treatment options for patients with varicose veins of the lower extremities.