CHIVA与闭合治疗非隐来源下肢静脉曲张的疗效比较

Efficacy comparison of CHIVA versus obliteration therapy in thetreatment of non-saphenous varicose veins of the lower limbs

背景与目的:非隐反流来源下肢静脉曲张血流动力学类型复杂,传统隐静脉主干闭合或抽剥可能遗漏反流静脉造成高复发率,目前常用治疗方法以射频消融术(RFA)、激光及硬化剂闭合为主,但未形成共识。本研究旨在探讨对比血流动力学纠正术(CHIVA)和RFA联合超声引导泡沫硬化剂(UGFS)闭合治疗非隐来源下肢静脉曲张的安全性和有效性。方法:选取2019年7月—2021年12月中南大学湘雅三医院连续收治并定期随访的非隐反流来源下肢静脉曲张患者共95例。其中41例行CHIVA治疗(CHIVA组),54例行RFA联合UGFS闭合(闭合组)。收集患者数据包括人口特征、反流静脉类型、分流通路类型、围术期情况、术后疗效、并发症、静脉临床严重程度评分(VCSS)。结果:CHIVA组平均手术时间明显少于闭合组(61.36 min vs. 78.15 min,P=0.000 5)、平均术中出血量明显少于闭合组(4.07 mL vs. 8.52 mL,P<0.000 1)、术中切口个数明显少于闭合组(1.58个vs. 3.65个,P<0.000 1);两组平均住院时间无明显差异(P>0.05)。CHIVA组色素沉着、血栓性静脉炎、血肿的发生率明显低于闭合组(4.9%vs. 24.1%;2.4%vs. 14.8%;0 vs. 11.1%,均P<0.05)。术后6个月,闭合组静脉曲张消退率明显优于CHIVA组(90.7%vs.70.7%, P<0.05), CHIVA组再干预率明显高于闭合组(29.3%vs.9.3%, P<0.05)。两组在术后12个月新发静脉曲张方面无明显差异(P>0.05)。术后6、12个月两组VCSS较术前均明显改善,但术后6个月时,CHIVA组较闭合组下降更明显(1.89 vs. 2.50,P<0.05);术后12个月时两组VCSS差异无统计学意义(P>0.05)。结论:CHIVA与闭合治疗相比,术后1年静脉曲张消退和生活质量相近,围术期指标更优、并发症更少,但术后6个月再干预需求更高。两者安全性和有效性相当,具体选择应依据所在中心技术设备、术者经验与患者诉求共同决策。

Background and Aims:The hemodynamic types of lower limb varicose veins arising from nonsaphenous tributaries are complex,and traditional treatment methods such as saphenous vein main trunk closure or stripping may miss reflux point,resulting in a high recurrence rate.Currently,commonly used treatment methods mainly include radiofrequency ablation(RFA),laser therapy,and foam sclerotherapy,but there has yet to be a consensus.This study aims to evaluate the safety and effectiveness of conservative hemodynamic correction of venous insufficiency(CHIVA)and RFA combined with ultrasound-guided foam sclerotherapy(UGFS)obliteration for non-saphenous varicose veins of the lower limbs.Methods:A total of 95 patients with lower limb varicose veins originating from non-saphenous sources,who were consecutively admitted to Xiangya Third Hospital of Central South University and followed up regularly from July 2019 to December 2021,were selected.Among them,41 patients underwent CHIVA treatment(CHIVA group),and 54 underwent RFA combined with UGFS obliteration(closure group).The data that included demographic characteristics,reflux vein types,shunt types,perioperative conditions,postoperative efficacy,complications,and Venous Clinical Severity Score(VCSS)were collected.Results:The CHIVA group had a significantly shorter average operative time than that of the closure group(61.36 min vs.78.15 min,P=0.0005),significantly less average intraoperative blood loss than that of the closure group(4.07 mL vs.8.52 mL,P<0.0001),a and significantly fewer incisions during the operation than that of the closure group(1.58 vs.3.65,P<0.0001);there was no significant difference in average hospital stay between the two groups(P>0.05).The incidence rates of pigmentation,thrombophlebitis,and hematoma in the CHIVA group were significantly lower than those in the closure group(4.9%vs.24.1%;2.4%vs.14.8%;0 vs.11.1%,all P<0.05).Six months after the operation,the varicose vein regression rate in the closure group was significantly higher than that in the CHIVA group(90.7%vs.70.7%,P<0.05).The reintervention rate in the CHIVA group was significantly higher than that in the closure group(29.3%vs.9.3%,P<0.05).There was no significant difference between the two groups regarding newly developed varicose veins 12 months after operation(P>0.05).Both groups showed significant improvement in VCSS at 6 and 12 months after operation compared to preoperative scores,but at 6 months after operation,the CHIVA group showed a more significant decrease compared with the closure group(1.89 vs.2.50,P<0.05);there was no statistically significant difference in VCSS between the two groups at 12 months after operation(P>0.05).Conclusion:Compared to obliteration therapy,CHIVA has similar outcomes in varicose vein regression and quality of life at postoperative 1 year,with better perioperative variables and fewer complications,but a higher demand for reintervention at postoperative 6 months.Both methods have comparable safety and effectiveness,and the specific choice should be based on the center's technical equipment,the surgeon's experience,and the patient's preferences.