局部麻醉射频消融联合硬化剂注射治疗老年大隐静脉曲张的疗效分析

Clinical analysis of radiofrequency ablation under local anesthesia combined with sclerotherapy embolization in the treatment of elderly patients with great saphenous vein varices

目的探讨局部麻醉下大隐静脉射频消融联合硬化剂注射与大隐静脉主干高位结扎联合透光旋切治疗老年大隐静脉曲张的安全性和有效性。方法收集2020年5月至2022年1月于首都医科大学附属北京朝阳医院就诊的157例老年大隐静脉曲张患者(176条患肢)的临床资料,按照手术方式的不同将其分为射频组和高位结扎组,其中,射频组76例患者84条患肢,采用局部麻醉下大隐静脉主干射频消融术+小腿浅静脉泡沫硬化剂注射+局部小切口点状抽剥;高位结扎组81例患者92条患肢,采用全身麻醉或腰部麻醉下大隐静脉主干高位结扎剥脱术+局部浅静脉透光旋切术。统计两组患者的手术相关指标,评估两组患者围手术期并发症发生情况,比较两组患者术后3、12个月静脉临床严重程度评分(VCSS),评估患者静脉曲张术后恢复情况。术后12个月,通过复查彩色多普勒超声评价射频组患者的大隐静脉主干再通情况。结果两组患者的手术成功率均为100%,射频组患者术后即可下地活动,而高位结扎组则需至少卧床6 h。射频组患者术中出血量小于高位结扎组患者,住院时间短于高位结扎组患者,但射频组患者手术时间长于高位结扎组患者,差异均有统计学意义(P﹤0.05)。两组患者深静脉血栓形成(DVT)、浅静脉炎及感染的发生率比较,差异均无统计学意义(P﹥0.05)。两组患者术后随访的VCSS均低于本组术前,差异均有统计学意义(P﹤0.05);但两组患者VCSS比较,差异无统计学意义(P﹥0.05)。射频组患者中64条患肢完成了12个月下肢血管彩色多普勒超声检查,大隐静脉主干的总闭合率为87.5%(56/64)。结论射频消融联合泡沫硬化剂注射加点式剥脱术治疗老年大隐静脉曲张患者安全可行,创伤小,恢复快,围手术期并发症少。

Objective To evaluate the safety and effectiveness of the great saphenous vein radiofrequency ablation under local anesthesia combined with sclerotherapy embolization and high ligation stripping combined with transilluminated powered phlebectomy in the treatment of elderly great saphenous vein varices.Method The clinical data of 157 elderly patients with great saphenous vein(176 limbs)admitted to Beijing Chao-yang Hospital,Capital Medical University from May 2020 to January 2022 were collected.A total of 76 patients(84 limbs)underwent radiofrequency ablation of great saphenous vein under local anesthesia+superficial calf vein sclerotherapy embolization+point stripping were included into the radiofrequency group;81 patients(92 limbs)underwent high ligation stripping+transilluminated powered phlebectomy under local anesthesia were included into the high ligation group.The operating-related indicators of patients in the two groups were counted,the occurrence of perioperative complications in the two groups was evaluated,the postoperative recovery of patients with varicose veins was evaluated by venous clinical severity score(VCSS)at 3 and 12 months after surgery.Twelve months after surgery,color Doppler ultrasound was used to evaluate the re-venation of the great saphenous vein in the radiofrequency group.Result The success rate of operation in both groups was 100%.Patients in the radiofrequency group were able to move to the ground after surgery,while those in the high ligation group were required to stay in bed for at least 6 hours.The intraoperative blood loss and operation time in radiofrequency group were longer than those in the high ligation group,and hospitalization time lower than that in the high ligation group,the differences were statistically significant(P<0.05).There were no significant differences in the incidence of deep venous thrombosis(DVT),phlebitis and infection between the two groups(P>0.05).The scores of VCSS during postoperative follow up in both groups were lower than those before surgery,the differences were statistically significant(P<0.05),but without significant difference of VCSS between the two groups(P>0.05).A total of 64 affected limbs underwent 12-month color Doppler ultrasonography of lower limb blood vessels,and the total closure rate of GSV in the radiofrequency group was 87.5%(56/64).Conclusion Radiofrequency ablation of GSV under local anesthesia combined with sclerotherapy embolization and point stripping is safe and feasible for the treatment of elderly GSV varices,which is less traumatic,fast recovery and has fewer perioperative complications.