腔内射频消融术联合透光旋切术与传统高位结扎剥脱术联合透光旋切术治疗下肢静脉曲张的疗效对比分析  

Comparison of radiofrequency ablation combined with transilluminated powered phlebectomy and high ligation and stripping combined with transilluminated powered phlebectomy in patients with varicose veins of lower limbs

作　　者：廖传军[1] 张望德[1] LIAO Chuanjun;ZHANG Wangde(Department of Vascular Surgery,Beijing Chaoyang Hospital,The Affiliated Hospital of Capital Medical University,Beijing 100020,P.R.China)

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,北京100020

出　　处：《中国普外基础与临床杂志》2021年第5期631-635,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较腔内射频消融术(radiofrequency ablation,RFA)联合透光旋切术(transilluminated powered phlebectomy,TIPP)和传统高位结扎剥脱术(high ligation and stripping,HLS)联合TIPP治疗下肢静脉曲张的疗效及其对患者生活质量的影响。方法回顾性收集2017年12月至2018年7月期间笔者所在医院收治的190例下肢静脉曲张患者(206条肢体)的临床资料,其中88例患者(96条肢体)接受了RFA联合TIPP,102例患者(110条肢体)接受了传统HLS联合TIPP。术后3个月和术后1年时采用静脉临床严重程度评分(venous clinical severity score,VCSS)和慢性静脉功能不全问卷评分(chronic venous insufficiency questionnaire,CIVIQ-14)评估患者的生活质量,采用多普勒超声评估大隐静脉闭合情况。结果RFA联合TIPP组的手术时间、术中出血量、住院时间、术后卧床时间以及术后恢复下肢正常活动时间均优于HLS组联合TIPP组(P<0.05)。在术后并发症方面,RFA联合TIPP组的皮肤硬结发生率和肢体麻木发生率低于HLS联合TIPP组(P<0.05)。在大隐静脉主干闭合率方面,术后3个月时RFA联合TIPP组的大隐静脉主干闭合率为93.8%(90/96),HLS联合TIPP组为97.3%(107/110);术后1年时RFA联合TIPP组为91.7%(88/96),HLS联合TIPP组为97.3%(107/110)。各时点2组患者的大隐静脉主干闭合率比较差异均无统计学意义(P>0.05)。无论是RFA联合TIPP组还是HLS联合TIPP组,术后3个月和术后1年的VCSS得分和CIVIQ-14得分均较术前有了明显改善(P<0.05),但同时点2组之间的VCSS得分和CIVIQ-14得分比较差异并无统计学意义(P>0.05)。结论RFA联合TIPP是治疗下肢静脉曲张的有效方法,与传统的HLS联合TIPP比较,具有同样良好的远期效果,且RFA联合TIPP具有手术时间短、患者术后恢复快和术后并发症少的优点。Objective To compare the effectiveness of radiofrequency ablation(RFA)combined with transilluminated powered phlebectomy(TIPP)vs.high ligation and stripping(HLS)combined with TIPP in patients with varicose veins of lower limbs.Methods A retrospective analysis was made on the clinical data of 190 patients(206 limbs)of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018,of them 88 patients(96 limbs)in RFA combined with TIPP group and other 102 patients(110 limbs)in HLS combined with TIPP group.The treatment effectiveness and quality of life was assessed with venous clinical severity score(VCSS)and chronic venous insufficiency questionnaire(CIVIQ-14)in three months and one year after surgery.Doppler ultrasound was used to evaluate the closure of great saphenous vein.Results Baseline characteristics were similar between the two groups(P>0.05).The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time,intraoperative bleeding,hospital stay time,postoperative bed time,resumption time of activities,as well as incidences of skin induration and limb numb(P<0.05).Occlusion rates of great saphenous vein in 3 months was93.8%(90/96)in the RFA combined with TIPP group and 97.3%(107/110)in the HLS combined with TIPP group,and in one year was 91.7%(88/96)and 97.3%(107/110)respectively,there was no significant difference between the two groups at the same time point(P>0.05).The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in3 months and 1 year follow up(P<0.05),but there was no significant differences between the two groups at the same time point(P>0.05).Conclusions RFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs.Compared with HLS,RFA has the same good effectiveness and quality of life,but it has the advantages of short operation time,rapid postoperative recovery,and less postoperative complications.

关 键 词：下肢静脉曲张 腔内射频消融术 高位结扎剥脱术 透光旋切术 静脉临床严重程度评分 慢性静脉功能不全问卷评分 

分 类 号：R654.4[医药卫生—外科学]