超声引导下微波消融与射频消融对下肢静脉曲张患者氧化应激反应、血流动力学的影响

Effects of Ultrasound-guided Microwave Ablation and Radiofrequency Ablation on Oxidative Stress and Hemodynamics in Patients with Varix of Lower Limbs

目的比较超声引导下微波消融(endovenous microwave ablation,EMA)与射频消融(radiofrequency ablation,RFA)联合泡沫硬化术治疗对下肢静脉曲张患者氧化应激反应、血流动力学的影响。方法随机选取2022年3月—2023年3月湖北省仙桃市第三人民医院普外科收治的120例下肢静脉曲张患者为研究对象,根据治疗方案的不同分为EMA组(n=62)和RFA组(n=58)。EMA组采用超声引导下EMA联合泡沫硬化剂注射治疗,RFA组接受超声引导下RFA联合泡沫硬化剂注射治疗。比较两组患者手术指标、血管术后一个月再通率、并发症发生率、Villalta量表评分与静脉临床严重程度量表评分(Venous Clinical Severity Score,VCSS)、氧化应激指标、疗效、血液动力学指标。结果两组术后6个月的VCSS、Villalta评分均明显下降,且EMA组的评分优于RFA组,差异有统计学意义(P均<0.05)。术后3 d,两组谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-PX)、超氧化物歧化酶(superoxide dismutase,SOD)、过氧化氢酶(catalase,CAT)水平均升高,丙二醛(malonaldehyde,MDA)水平降低,且EMA组上述指标均优于RFA组(P均>0.05)。两组术后3 d的全血黏度、平均纤维蛋白原、血浆黏度及红细胞比积水平均较术前降低,且EMA组低于RFA组,差异有统计学意义(P均<0.05)。EMA组临床治疗总有效率高于RFA组,差异有统计学意义(P<0.05)。两组患者术后一个月再通率及术后并发症总发生率比较,差异无统计学意义(P均>0.05)。结论相比射频消融,微波消融联合泡沫硬化术能有效改善下肢静脉曲张患者术后氧化应激、血流动力学指标,治疗效果显著。

Objective To investigate the effects of ultrasound-guided microwave ablation(EMA)and radiofrequency ablation(RFA)combined with foam sclerotherapy on oxidative stress and hemodynamics in patients with varix of lower limbs.Methods A total of 120 patients with varix of lower limbs admitted to the Department of General Surgery of Xiantao Third People's Hospital from March 2022 to March 2023 were selected randomly as the research subjects and divided into the EMA group(n=62)and the RFA group(n=58)according to different treatment plans.All of them were treated with ultrasound-guided EMA therapy combined with foam sclerotherapy in the EMA group,while the RFA group received ultrasound-guided RFA therapy combined with foam sclerotherapy.The surgical indicators,one month postoperative recanalization rate,incidence of complications,scores of Villalta Scale and Venous Clinical Severity Score(VCSS),oxidative stress indicators,efficacy,and hemodynamic indicators between two groups of patients were compared.Results The VCSS and Villalta score of patients in both groups decreased significantly after 6 months postoperatively,and the scores in the EMA group were better than those in the RFA group,and the differences were statistically significant(both P<0.05).After 3 days postoperatively,the levels of glutathione peroxidase(GSH-PX),superoxide dismutase(SOD)and catalase(CAT)were increased,and the levels of malonaldehyde(MDA)were decreased in two groups.In the EMA group,CAT(10.31±1.09)U/mL,GSH-PX(5.43±0.51)g/L,and SOD(12.76±1.47)U/L were higher than those in the RFA group(8.36±0.98)U/mL,(5.06±0.44)g/L,and(12.18±1.53)U/L,and the differences were statistically significant(t=10.281,4.242,29.940,all P<0.05).And MDA(10.07±1.65)μmol/L in the EMA group was lower than(10.73±1.68)μmol/L of the RFA group,and the difference was statistically significant(t=2.169,P=0.032).Whole blood viscosity,mean fibrinogen,plasma viscosity and erythrocyte specific effusion were lower in two groups at 3 days postoperatively compared to preoperatively,and those in the EMA group were lower than in the RFA group,and the differences were statistically significant(all P<0.05).The total effective rate of clinical treatment in the EMA group was higher than that in the RFA group,and the difference was statistically significant(P<0.05).There were no statistically significant differences in the rate of one month postoperative recanalization and total incidence of postoperative complications between the two groups of patients(both P>0.05).Con⁃clusion Microwave ablation compared with radiofrequency ablation combined with foam sclerotherapy can effectively improve the patients'postoperative oxidative stress,hemodynamic indexes,and the therapeutic effect is significant.