腔内射频消融术治疗原发性重度大隐静脉曲张的临床疗效研究

Analysis of clinical efficacy of intracavitary radio-frequency ablation in the treatment of severe primary great saphenous varicose veins

目的探讨腔内射频消融术(RFA)与传统高位结扎剥脱术治疗原发性重度大隐静脉曲张的临床疗效差异。方法收集2022年9月至2023年6月于首都医科大学附属北京朝阳医院就诊的65例(65条患肢)原发性重度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腔内射频组(n=33,共33条患肢)和高位结扎组(n=32,共32条患肢)。比较两组患者的手术相关指标[手术成功率、术中出血量、手术时间、术后视觉模拟评分法(VAS)评分、总住院时间]、术后2周并发症发生情况[静脉内热诱导血栓形成(EHIT)、深静脉血栓形成(DVT)、血栓性浅静脉炎、皮下血肿或瘀斑、切口感染和隐神经损伤]。采用修订后的静脉临床严重程度评分(VCSS)评估并比较不同时间(术前、术后2周、术后3个月、术后6个月)的静脉曲张严重程度。观察术后6个月腔内射频组患者的大隐静脉主干闭合情况。结果两组患者的技术成功率均为100%。腔内射频组的手术时间和总住院时间均短于高位结扎组患者,术中出血量少于高位结扎组患者,差异均有统计学意义(P<0.05)。腔内射频组患者皮下血肿或瘀斑发生率及围手术期并发症发生率均明显低于高位结扎组患者,差异均有统计学意义(P<0.01)。两组患者术后2周均未出现EHIT和DVT。两组患者术前、术后2周、术后3个月、术后6个月的VCSS比较,差异均无统计学意义(P>0.05),但两组患者术后2周、3个月、6个月的VCSS均低于本组术前,差异均有统计学意义(P<0.05)。术后6个月,腔内射频组患者患肢大隐静脉主干的总闭合率为100%(33/33)。结论与传统高位结扎剥脱术相比,RFA是原发性重度大隐静脉曲张更加安全、有效的治疗方式。

Objective To compare the difference of clinical efficacy between intracavitary radiofrequency ablation(RFA)and traditional high ligation and stripping surgery in the treatment of severe primary great saphenous varicose veins.Method The clinical data of 65 patients(65 affected limbs)with severe great primary saphenous varicose veins admitted to Beijing Chao-yang Hospital,Capital Medical University from September 2022 to June 2023 were collected.Patients were divided into intracavitary radiofrequency group(n=33,a total of 33 affected limbs)and high ligation group(n=32,a total of 32 affected limbs)according to different surgical methods.The surgical related indicators[surgical success rate,intraoperative blood loss,surgical time,postoperative visual analogue scale(VAS)score,total length of hospital stay]and incidence of complications[endovenous heat-induced thrombosis(EHIT),deep venous thrombosis(DVT),thrombotic superficial phlebitis,subcutaneous hematoma or bruising,incision infection,and saphenous nerve injury]at 2 weeks after surgery between two groups of patients were compared.The severity of varicose veins at different times(preoperative,2 weeks postoperative,3 months postoperative,and 6 months postoperative)were evaluated and compared using the revised venous clinical severity score(VCSS).The closure of the main great saphenous vein in patients in the intracavitary radiofrequency group at 6 months after surgery was observed.Result The surgical success rate of both groups of patients was 100%.The surgical time and total length of hospital stay in the intracavitary RFA group were shorter lower than those in the high ligation group,the intraoperative blood loss in the intracavitary radiofrequency group was lower than those in the high ligation group,and the differences were statistically significant(P<0.05).The incidence of subcutaneous hematoma or bruising and perioperative complications in the intracavitary radiofrequency group were significantly lower than those in the high ligation group,and the differences were statistically significant(P<0.01).Both groups of patients did not show any EHIT or DVT after 2 weeks of surgery.The VCSS scores of the two groups of patients before surgery,2 weeks,3 months,and 6 months after surgery were compared,and there were no statistically significant differences(P>0.05).However,the VCSS scores of the two groups of patients at 2 weeks,3 months,and 6 months after surgery were lower than those before surgery,and the differences were statistically significant(P<0.05).In the intracavitary radiofrequency group,the total closure rate of the main great saphenous vein was 100%(33/33).Conclusion RFA therapy is a safe and effective treatment method for severe primary great saphenous varicose veins,compraing to the high ligation and stripping surgery treatment.