射频消融术、改良大隐静脉高位结扎剥脱术分别联合泡沫硬化剂治疗大隐静脉曲张的效果比较

Comparison of the efficacy of radiofrequency ablation,modified high ligation and exfoliation of the great saphenous vein combined with foamsclerotherapy for varicose great saphenous vein

目的探讨射频消融术、改良大隐静脉高位结扎剥脱术分别联合泡沫硬化剂治疗对大隐静脉曲张患者的治疗效果。方法收集2021年3月至2022年6月北京中医药大学附属护国寺中医医院收治的88例大隐静脉曲张患者的临床资料,按照治疗方式的不同将其分为射频消融组(n=45,采用射频消融联合泡沫硬化剂治疗)和改良高位结扎剥脱术组(n=43,采用改良下隐静脉高位结扎点式剥脱术联合泡沫硬化剂治疗)。比较两组患者手术情况、术后并发症和复发情况、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平、视觉模拟评分法(VAS)评分、静脉临床严重程度评分(VCSS)。结果射频消融组患者术中出血量低于改良高位结扎剥脱组患者,手术时间、术后住院时间均短于改良高位结扎剥脱术组患者,差异均有统计学意义(P﹤0.05)。改良高位结扎剥脱术组患者复发率为4.65%(2/43),与射频消融组患者的2.22%(1/45)比较,差异无统计学意义(P﹥0.05)。改良高位结扎剥脱术组患者皮下血肿、切口愈合不良发生率均高于射频消融组患者,差异均有统计学意义(P﹤0.05)。治疗后,两组患者各炎症因子水平均高于本组术前,但射频消融组患者的各炎症因子水平均低于改良高位结扎剥脱术组患者,差异均有统计学意义(P﹤0.05)。治疗后,两组患者VCSS、VAS评分均低于本组术前,且射频消融组患者VCSS、VAS评分均低于改良高位结扎剥脱术组患者,差异均有统计学意义(P﹤0.05)。结论射频消融术、改良高位结扎剥脱术分别联合泡沫硬化剂对大隐静脉曲张均具有一定的治疗效果,其中射频消融术联合泡沫硬化剂能减少患者术中出血量,缩短患者的手术时间、住院时间,减轻疼痛,并发症少且静脉曲张患者的术后炎症反应较轻,更利于恢复。

Objective To explore the therapeutic effect of radiofrequency ablation,modified high ligation and stripping of great saphenous vein combined with foam sclerotherapy on patients with great saphenous varicose vein.Method The clinical data of 88 patients with varicose great saphenous vein admitted to Huguosi Hospital of Traditional Chinese Medicine affiliated with Beijing University of Chinese Medicine and Pharmacology from March 2021 to June 2022 were retrospectively collected.According to different treatment methods,they were divided into radiofrequency ablation group(n=45,treated with radiofrequency ablation combined with foam sclerosing agent)and modified high ligation stripping group(n=43,treated with modified high ligation point stripping combined with foam sclerosing agent).The surgical conditions,postoperative complications and recurrence,inflammatory cytokine levels[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)],visual analogue scale(VAS)scores,and venous clinical severity score(VCSS)between two groups of patients were compared.Result The intraoperative bleeding volume of patients in the radiofrequency ablation group was lower than that in the modified high ligation stripping group,the surgical time and postoperative hospital stay were shorter than those in the modified high ligation stripping group,with statistical significance(P<0.05).The recurrence rate of patients in the modified high ligation stripping group was 4.65%(2/43),and compared with the 2.22%(1/45)of patients in the radiofrequency ablation group,the difference was not statistically significant(P>0.05).The incidence rate of subcutaneous hematoma and poor wound healing in modified high ligation stripping group was higher than that in radiofrequency ablation group,the differences were statistically significant(P<0.05).After treatment,the levels of various inflammatory factors in both groups of patients were higher than before surgery,but the levels of various inflammatory factors in the radiofrequency ablation group were lower than those in the modified high ligation stripping group,and the differences were statistically significant(P<0.05).After treatment,the VCSS and VAS scores of both groups of patients were lower than before surgery,and the VCSS and VAS scores of patients in the radiofrequency ablation group were lower than those in the modified high ligation stripping group,with statistical significance(P<0.05).Conclusion Radiofrequency ablation,modified high ligation and stripping,respectively,combined with foam sclerosing agent,has a certain therapeutic effect on the treatment of varicose veins of great saphenous vein.Among them,radiofrequency ablation combined with foam sclerosing agent can reduce the amount of intraoperative bleeding,shorten the operation time and hospital stay of patients,reduce pain,have fewer complications,and have less postoperative inflammatory reaction in patients with varicose veins,which is more conducive to recovery.