激光闭合联合硬化剂腔内注射治疗大隐静脉曲张的临床疗效

Clinical efficacy of laser closure combined intracavitary injection of sclerosing agent in great saphenous varicose

目的 探讨激光闭合联合硬化剂腔内注射治疗大隐静脉曲张(GSV)的临床疗效。方法 收集2020年1月至2022年6月于首都医科大学大兴教学医院就诊的196例GSV患者的临床资料,根据治疗方法的不同将其分为硬化组(n=98,接受单纯硬化剂腔内注射治疗)与联合组(n=98,接受激光闭合联合硬化剂腔内注射治疗)。比较两组患者临床指标(手术时间、术中出血量、泡沫硬化剂用量、住院时间),术前、术后24 h血清炎性因子水平[C反应蛋白(CRP)、白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)],凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)],血管内皮功能指标[血管内皮细胞生长因子(VEGF)、内皮细胞计数(CEC)、内皮素(ET)-1、一氧化氮(NO)水平],统计两组患者术后并发症发生率及随访3个月后二次干预率。结果 联合组患者手术时间、住院时间均长于硬化组患者,术中出血量高于硬化组患者,泡沫硬化剂用量少于硬化组患者,差异均有统计学意义(P﹤0.05)。术后24 h,两组患者IL-6、TNF-α、CRP水平均高于本组术前,联合组患者上述指标均低于硬化组患者,差异均有统计学意义(P﹤0.05)。术后24 h,两组患者APTT、PT、TT均短于本组术前,FIB、D-D水平均高于本组术前,但联合组患者PT、APTT、TT均长于硬化组患者,FIB、D-D水平均低于硬化组患者,差异均有统计学意义(P﹤0.05)。术后24 h,两组患者CEC、VEGF、ET-1水平均低于本组术前,NO水平均高于本组术前,联合组患者CEC、VEGF、ET-1水平均低于硬化组患者,NO水平高于硬化组患者,差异均有统计学意义(P﹤0.05)。联合组术后并发症总发生率与二次干预率均低于硬化组患者,差异均有统计学意义(P﹤0.05)。结论 激光闭合联合硬化剂腔内注射治疗GSV疗效较好,可降低二次干预发生率,减少硬化剂用量,减轻患者术后炎性反应,改善患者的血管内皮功能与凝血功能,提高治疗安全性。

Objective To explore the clinical efficacy of laser closure combined with intracavitary injection of sclerosing agent in the treatment of great saphenous varicose(GSV).Method Clinical data of 196 patients with GSV admitted in the Daxing Hospital,Capital Medical University from January 2020 to June 2022 were collected and all patients were divided into the sclerosing group(n=98,received intracavitary injection of sclerosing agent)and the combined group(n=98,received laser closure+intracavitary injection of sclerosing agent)according to different treatment methods.The clinical indicators of operation time,intraoperative blood loss,foam sclerosing agent dosage and hospital stay,serum inflammatory factor of C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)before and 24 h after operation,coagulation function indexes of thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer(D-D),vascular endothelial function indexes of vascular endothelial growth factor(VEGF),endothelial cell count(CEC),endothelin(ET)-1,and nitric oxide(NO),incidence of postoperative complications and incidence of secondary intervention after 3 months of follow up were compared in the two groups.Result The operation time and hospital stay of patients in the combined group were longer than those in the sclerosing group,the intraoperative blood flow was higher than that in the sclerosing group,and the amount of foam sclerosing agent was lower than that in the sclerosing group,the differences were statistically significant(P<0.05).After operation 24 h,IL-6,TNF-αand CRP in both groups increased than those before operation,with lower levels in the combined group than those in the sclerosing group,the differences were statistically significant(P<0.05).After operation 24 h,the APTT,PT,and TT in both groups were lower than those before operation,the FIB and D-D higher than those before operation,however,the PT,APTT,and TT of patients in the combination group were longer than those in the sclerosis group,while FIB and D-D were lower than those in the sclerosis group,the differences were statistically significant(P<0.05).After operation 24 h,the levels of CEC,VEGF and ET-1 in both groups were lower and level of NO were higher than those before operation,the levels of CEC,VEGF,and ET-1 in the combined group of patients were lower than those in the sclerosis group,and NO was higher than that in the sclerosis group,the differences were statistically significant(P<0.05).The total incidence of postoperative complications and the secondary intervention rate in the combined group were lower than those in the sclerosing group,the differences were statistically significant(P<0.05).Conclusion Laser closure+intracavitary injection of sclerosing agent has significant efficacy in the treatment of GSV,which can reduce the incidence of secondary intervention,reduce dosage of sclerosing agent,alleviate postoperative inflammatory reaction,regulate vascular endothelial function and blood coagulation function,and improve the safety of treatment.