腔内激光消融术与传统手术对小隐静脉曲张的治疗效果对比分析

Comparative analysis of the efficacy of endovenous laser ablation and traditional surgery in the treatment of small saphenous varicose veins

目的探讨腔内激光消融术(EVLA)与传统手术对小隐静脉曲张的治疗效果。方法收集2012年2月至2021年9月于苏州市立医院住院治疗的56例小隐静脉曲张患者的临床资料,按照治疗方式的不同将患者分为EVLA组(n=20)和手术组(n=36)。比较两组患者的小隐静脉曲张严重程度[临床严重程度评分(VCSS)]、生活质量[欧洲五维健康量表(EQ-5D)]、围手术期相关指标、术后复发及并发症发生情况。结果两组患者的术后VCSS评分均低于本组术前,EQ-5D评分均高于本组术前,差异均有统计学意义(P﹤0.05)。两组患者术前、术后的VCSS和EQ-5D评分比较,差异均无统计学意义(P﹥0.05)。EVLA组患者的腘窝坐骨神经阻滞麻醉比例明显高于手术组患者,住院时间明显短于手术组患者,差异有统计学意义(P﹤0.01)。EVLA组中1例临床表现-病因学-解剖学-病理生理学(CEAP)分级为C6级的患者术后小隐静脉曲张合并小腿背侧溃疡复发,经再次EVLA治疗后溃疡愈合,未见其他严重并发症发生;手术组1例CEAP分级为C5级的患者术后出现腓肠神经损伤,未出现复发病例。结论腔内激光消融术和传统手术治疗小隐静脉曲张的效果均较好,疗效相当,但激光消融治疗法操作简便,住院时间短,并发症少,值得临床推广应用。

Objective To investigate the efficacy of endovenous laser ablation(EVLA)and traditional surgery in the treatment of small saphenous varicose veins.Method The clinical data of 56 patients with small saphenous varicose veins admitted to the Suzhou Municipal Hospital from February 2012 to September 2021 were collected and divided into EVLA group(n=20)and traditional surgery group(n=36)according to the different treatment methods.The severity of small saphenous varicose veins[venous clinical severity score(VCSS)],quality of life[European five-dimensional health questionnaire(EQ-5D)],perioperative related indicators,postoperative recurrence and incidence of complications were compared between the two groups of patients.Result The postoperative VCSS scores of both groups of patients were lower than those before surgery,higher postoperative EQ-5D scores were observed than those before surgery,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the preoperative and postoperative VCSS and EQ-5D scores between the two groups of patients(P>0.05).The proportion of patients in the EVLA group receiving popliteal sciatic nerve block anesthesia was significantly higher than that in the traditional surgery group,and the hospitalization time of EVLA group patients was significantly shorter than that of traditional surgery group patients,and the difference was statistically significant(P<0.01).One patient in the EVLAgroup with clinical etiology anatomy pathophysiology(CEAP)grade C6 experienced recurrence of small saphenous vein varicose vein combined with dorsal leg ulcer after surgery,and then no other serious complications occurred after the treatment of EVLA treatment again.One patient in the traditional surgery group with CEAP grade C5 experienced postoperative sural nerve injury,and no recurrent cases were found.Conclusion The two methods of EVLA and traditional surgery in the treatment of small saphenous varicose vein can receive good efficacy,with comparable efficacy,but the EVLA is easier to operate,with short hospitalization time and fewer complications,and it is worthy of clinical promotion and application.