分段腔内热消融联合泡沫硬化剂注射治疗对膝下大隐静脉反流的临床疗效

Clinical efficacy of segmental endovenous thermal ablation combined with foam sclerotherapy for the treatment of below-knee great saphenous veins reflux

目的探讨分段腔内热消融联合泡沫硬化剂注射治疗对膝下大隐静脉(BK-GSV)反流的临床疗效。方法收集2022年9月至2023年5月于复旦大学附属中山医院青浦分院接受治疗的232例大隐静脉曲张患者的临床资料,根据BK-GSV反流处理方式的不同将患者分为分段消融组(n=93)和腔内激光消融(EVLA)组(n=139)。观察并比较两组患者的围手术期相关指标(手术成功率、手术相关并发症、死亡情况)和中远期随访结果[大隐静脉(GSV)主干再通率、膝下静脉曲张复发率、二次干预率、隐神经损伤情况]。结果两组患者的手术成功率均为100%,GSV均完全闭合。两组患者围手术期均未出现严重的手术相关并发症和死亡事件。两组患者术后切口感染、瘀斑的发生率比较,差异均无统计学意义(P﹥0.05)。分段消融组患者小腿内侧皮肤感觉异常、疼痛及灼伤的总发生率低于EVLA组患者,差异有统计学意义(P=0.033),且均于术后1个月逐步恢复。两组患者中远期GSV主干再通率、膝下静脉曲张复发率及二次干预率比较,差异均无统计学意义(P﹥0.05)。分段消融组患者术后1个月隐神经损伤的发生率为2.5%(2/79),低于EVLA组患者的10.2%(12/117),差异有统计学意义(P﹤0.05)。结论分段腔内热消融联合泡沫硬化剂注射治疗BK-GSV反流是一种安全、有效的方法,能降低隐神经损伤的发生风险,并与传统EVLA在中远期GSV主干再通率、膝下静脉曲张复发率及二次干预率方面无明显差异。

Objective To investigate the clinical efficacy of segmental endovenous thermal ablation combined with foam sclerotherapy for the treatment of below-knee great saphenous vein(BK-GSV)reflux.Method The clinical data of 232 patients with great saphenous varicose vein who received treatment at Zhongshan Hospital Qingpu Branch,Fudan University from September 2022 to May 2023 were collected.According to the different BK-GSV reflux treatment methods,the patients were divided into segmented ablation group(n=93)and endovenous laser ablation(EVLA)group(n=139).The perioperative related indicators(surgical success rate,surgical complications,mortality)and mid to long term follow-up results[great saphenous vein(GSV)main recanalization rate,recurrence rate of below-knee varicose veins,secondary intervention rate,and saphenous nerve injury]between two groups of patients were observed and compared.Result The success rate of surgery for both groups of patients was 100%,and the GSV was completely closed.During the perioperative period,neither group of patients experienced serious surgical related complications or mortality events.There were no statistically significant differences in the incidence of postoperative incision infection and bruising between the two groups of patients(P>0.05).The total incidence of sensory abnormalities,pain,and burns on the inner skin of the calf in the segmented ablation group was lower than that in the EVLA group,and the difference was statistically significant(P=0.033),and all gradually recovered one month after surgery.There were no statistically significant differences in the mid to long term GSV main recanalization rate,recurrence rate of below-knee varicose veins,secondary intervention rate between the two groups of patients(P>0.05).One month after surgery,the incidence of saphenous nerve injury in the segmented ablation group was 2.5%(2/79),which was lower than the 10.2%(12/117)in the EVLA group,and the difference was statistically significant(P<0.05).Conclusion Segmental endovenous thermal ablation combined with foam sclerotherapy for the treatment of BK-GSV reflux is a safe and effective method that significantly reduces the risk of saphenous nerve injury.Compared with traditional EVLA,there were no significant differences in the mid to long term GSV main recanalization rate,recurrence rate of varicose veins and secondary intervention rate.