泡沫硬化剂联合激光治疗大隐静脉曲张的临床疗效及对纤维蛋白原水平的影响

Combined Clinical Effect of Foam Sclerotherapy and Laser Closure on Varicose Great Saphenous Vein&Its Impact on Fibrinogen Levels

目的探究泡沫硬化剂联合激光闭合与单纯激光闭合治疗大隐静脉曲张对纤维蛋白原(fibrinogen,FIB)水平及静脉临床严重程度(venous clinical severity score,VCSS)评分的影响。方法选择2022年1月至2022年12月,大隐静脉曲张患者90例,采用单双数法分为两组,每组患者45例,其中常规组采用单纯大隐静脉激光闭合术进行治疗,对大隐静脉主干进行光凝,功率12~16 W;试验组在其基础上加入泡沫硬化剂进行治疗,每个穿刺部位注入1~2 ml,总注射量≤20 ml。记录两组患者的临床疗效和手术情况,包括手术时长、术中出血量、住院时间、切口长度及切口数量。术前和术后1周检测FIB的表达、炎症因子包括血清白细胞介素(interleukin,IL)-2、IL-10及肿瘤坏死因子-α(tumor necrosis factor,TNF-α)的指标水平。术前和术后6个月使用VCSS评分量表对两组患者静脉临床严重程度进行评定。同时记录两组患者发热、静脉炎、皮下血肿、皮肤感觉障碍及隐神经损伤等并发症发生情况。结果(1)试验组患者临床疗效总有效率为95.6%,与常规组80.0%相比,显著升高(P<0.05)。(2)试验组患者各项手术指标均显著低于常规组(均P<0.05)。(3)术后1周,两组患者的FIB水平均较治疗前降低,其中以试验组患者FIB水平降低最为明显(P<0.05)。(4)术后6个月,与常规组相比,试验组患者VCSS评分(4.24±1.4)分降低明显(P<0.05)。(5)术后1周,试验组患者的各项炎症因子指标水平均优于常规组(均P<0.05)。(6)试验组患者发热、静脉炎、皮下血肿、皮肤感觉障碍及隐神经损伤的发生比例均低于常规组(P<0.05)。结论采用泡沫硬化剂联合激光治疗大隐静脉曲张的方法能够显著地提高临床疗效,改善患者的手术指标、机体炎症状态,调节FIB水平,降低VCSS评分,治疗安全性更高。

Objective To investigate the joint effect of foam sclerotherapy and laser closure in treating varicose great saphenous vein and its impact on fibrinogen(FIB)levels and venous clinical severity scores(VCSS).Methods Totally 90 patients with varicose saphenous veins diagnosed and treated between Jan.2022 and Dec.2022 were selected and divided into two groups with the odd-even method:a convention group(n=45),in which the patients were given simple saphenous vein laser closure(laser photocoagulation power:12-16 W)for the main trunk of saphenous vein,and a test group,in which the patients were injected 1-2 ml foam sclerosing agent in each puncture site besides the laser closure.The clinical efficacy and surgical conditions of the two groups were recorded,including the length of surgery,volume of intraoperative bleeding,duration of hospitalization,length of incision and number of incisions.The expression of FIB and levels of inflammatory factors(including IL-2 and IL-10)and tumor necrosis factor-α(TNF-α)were measured before the operation and 1 week after the operation respectively.The clinical severity of veins in both groups was assessed with VCSS rating scale before the operation and 6 months after the operation respectively.The complications incurred such as fever,phlebitis,subcutaneous hematoma,skin sensory impairment and saphenous nerve injury were also recorded for both groups.Results(1)The total clinical efficacy rate(95.6%)in the test group was higher than that(80.0%)in the convention group(P<0.05).(2)All the surgical indicators of patients in the test group were significantly lower than those in the convention group(P<0.05).(3)One week after the surgery,the FIB levels of patients in both groups were lower than those before the treatment,and the reduction was more obvious in the test group(P<0.05).(4)Six months after the surgery,compared with the patients in the convention group,the patients in the test group had a much lower VCSS score(4.24±1.43)(P<0.05).(5)One week after the surgery,the levels of all the indicators of inflammatory factors were better in the test group than in the convention group(P<0.05).(6)The incidence of fever,phlebitis,subcutaneous hematoma,cutaneous sensory disturbances and saphenous nerve injury was lower in the test group than in the convention group(P<0.05).Conclusions In the process of intervention in patients with varicose great saphenous veins,the combined use of foam sclerotherapy and laser closure will significantly improve the clinical efficacy and surgical indexes of the patient,regulate the level of FIB,reduce the VCSS score,improve the state of inflammation in body and provide a higher level of therapeutic safety.