日间手术模式下腔内射频消融术与静脉剥脱导管主干剥脱术治疗大隐静脉曲张疗效比较

Comparison of intraluminal radiofrequency ablation of great saphenous varicose vein and venous stripping catheter trunk stripping under day surgery mode

目的比较日间手术模式下大隐静脉腔内射频消融术与静脉剥脱导管主干剥脱治疗大隐静脉曲张的安全性及有效性。方法收集2020年2月至2021年1月大连市金州区第一人民医院收治的84例行日间手术的大隐静脉曲张患者的临床资料,根据手术方式的不同将患者分为射频组(n=44,采用大隐静脉主干射频消融术+小腿浅表静脉泡沫硬化+部分小切口点状抽剥治疗)和剥脱组(n=40,采用大隐静脉主干静脉剥脱导管剥脱术+小腿浅表静脉泡沫硬化+部分小切口点状抽剥治疗)。比较两组患者的手术指标、手术并发症发生情况、视觉模拟量表(VAS)评分,以及术后6~12个月静脉临床严重程度评分(VCSS)。结果所有患者均以日间手术模式成功完成手术。两组患者的手术时间及术中出血量比较,差异均无统计学意义(P>0.05)。射频组患者的术中VAS评分明显高于剥脱组患者,差异有统计学意义(P<0.01)。两组患者术后均未出现严重并发症和神经损伤。剥脱组患者术后皮下瘀斑的发生率明显高于射频组患者,差异有统计学意义(P<0.01)。结论日间手术模式下静脉剥脱导管行大隐静脉主干剥脱治疗大隐静脉曲张,能达到与腔内射频消融相似的术后快速康复效果,疗效确切,疼痛程度较轻,安全性较高,值得临床推广。

Objective To compare the safety and efficacy of intraluminal radiofrequency ablation of the great saphenous vein and venous stripping catheter trunk stripping in the treatment of great saphenous varicose vein under day surgery mode.Method The clinical data of 84 patients with great saphenous varicose vein who underwent day surgery from February 2020 to January 2021 in the First People's Hospital of Jinzhou District in Dalian were collected.The patients were divided into a radiofrequency group(n=44,using radiofrequency ablation of the great saphenous vein+foam sclerosis of the superficial calf vein+partial small incision punctiform stripping)and a stripping group(n=40,using the great saphenous vein stripping catheter stripping+superficial calf Intravenous foam sclerosis+some small incision punctiform stripping).The surgical indicators,the incidence of surgical complications,visual analogue scale(VAS)score and the venous clinical severity score(VCSS)at 6-12 months after the surgery were compared between the two groups.Result All patients underwent successful surgery in the day surgery mode.There was no significant difference in the operation time and intraoperative blood loss volume between the two groups(P>0.05).The intraoperative VAS score of the patients in the radiofrequency group was significantly higher than that in the ablation group,the difference was statistically significant(P<0.01).There were no serious postoperative complications and nerve injuries reported in the two groups.The incidence of postoperative subcutaneous ecchymosis in the stripping group was significantly higher than that in the radiofrequency group,and the difference was statistically significant(P<0.01).Conclusion The stripping of the great saphenous vein trunk,based on the employment of venous stripping catheter under day surgery mode,of great saphenous varicose vein,could achieve a comparable rapid postoperative recovery effect as endoluminal radiofrequency ablation.The foregoing method could achieve an relaible curative effect,low-level pain,and high safety,which is worthy of clinical promotion.