射频消融术与大隐静脉高位结扎剥脱术治疗下肢静脉曲张的疗效比较  

Comparison of the efficacy of radiofrequency ablation and high ligation with stripping in the treatment of lower limb varicose veins

作　　者：王硕 杨耀国[1] 唐小斌[1] 寇镭[1] 吴章敏[1] 王盛[1] 何楠[1] 张征[1] 张腾飞[1] 陈忠[1] WANG Shuo;YANG Yaoguo;TANG Xiaobin;KOU Lei;WU Zhangmin;WANG Sheng;HE Nan;ZHANG Zheng;ZHANG Tengfei;CHEN Zhong(Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Bejing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院血管外科,北京100029

出　　处：《中国普通外科杂志》2023年第6期899-908,共10页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(82000449)。

摘　　要：背景与目的:大隐静脉高位结扎剥脱术(HSL)是治疗下肢静脉曲张的经典术式,但存在创伤较大、恢复时间较长、切口瘢痕不美观等缺点。随着医疗技术的进步,以腔内热消融治疗为代表的微创治疗技术蓬勃发展。本研究旨在对比射频消融术(RFA)与传统HSL治疗下肢静脉曲张的临床疗效。方法:回顾性分析2021年5月—2022年6月期间因原发性下肢静脉曲张于首都医科大学附属北京安贞医院血管外科行手术治疗的272例患者(298条肢体)的临床与随访资料,其中96例(100条肢体)行RFA治疗(RFA组),176例(198条肢体)行HSL治疗(HSL组)。比较两组患者的术前临床特征、手术情况、并发症情况、临床表现-病因学-解剖学-病理生理学(CEAP)分级、静脉临床严重程度评分(VCSS)和慢性静脉功能不全问卷-14问版(CIVIQ-14)评分的变化情况。结果:两组技术成功率均为100%,术后3 d复查超声提示大隐静脉主干缺如/闭合率为100%。共完成随访265例(290条肢体),平均随访时间(13.2±3.8)个月,随访期间超声提示大隐静脉主干缺如/闭合率为100%。两组患者的基本临床特征无明显差异(均P>0.05);与HSL组比较,RFA组术中出血量(21.3 mL vs. 46.8 mL)、术后第1天疼痛评分(3.1 vs. 3.3)、总并发症发生率(25.5%vs. 38.0%)及皮肤感觉异常发生率(5.1%vs. 24.0%)均明显降低(均P<0.05),RFA组的深静脉血栓形成发生率升高(5.1%vs. 0,P<0.05);术后所有患者CEAP分级均较术前降级,RFA组81.7%的患肢降级为C0~C1级,HSL组83.9%的患肢降级为C0~C1级;所有患者的VCSS和CIVIQ-14评分均较术前有所改善,且HSL组的VCSS评分改善程度大于RFA组(均P<0.05)。结论:RFA短期疗效与HSL相当,相对于HSL而言,创伤更小、疼痛感更轻、并发症发生率更低,是一种下肢静脉曲张的有效治疗方案。Background and Aims:High ligation and stripping(HLS)of the great saphenous vein is a classic procedure for the treatment of varicose veins of the lower limbs.However,it has drawbacks such as significant trauma,longer recovery time,and unsightly incision scars.With the advancement of medical technology,minimally invasive treatment techniques,represented by endovenous thermal ablation,have flourished.This study aims to compare the clinical efficacy of radiofrequency ablation(RFA)with traditional HLS for the treatment of lower extremity varicose veins.Methods:The clinical and follow-up data of 272 patients(298 limbs)who underwent surgical treatment for primary lower extremity varicose veins at Beijing Anzhen Hospital,Capital Medical University,from May 2021 to June 2022 were retrospectively analyzed.Of the patients,96 cases(100 limbs)underwent RFA treatment(RFA group),and 176 cases(198 limbs)underwent HLS treatment(HSL group).The preoperative clinical characteristics,surgical details,complications,changes in clinical-etiologicalanatomical-pathophysiological(CEAP)classification,venous clinical severity score(VCSS),and Chronic Venous Insufficiency Questionnaire-14 items(CIVIQ-14)scores were compared between the two groups.Results:The technical success rate was 100%in both groups,and ultrasound examinations on postoperative day 3 showed a 100%absence/closure rate of the main trunk of the great saphenous vein.A total of 265 patients(290 limbs)completed the follow-up,with a mean follow-up time of(13.2+3.8)months.During the follow-up period,the absence/closure rate of the main trunk of the great saphenous vein was 100%as indicated by ultrasound in both groups.There were no significant differences in the basic clinical characteristics between the two groups(all P>0.05).Compared to the HSL group,the RFA group had significantly lower intraoperative blood loss(21.3 mL vs.46.8 mL),postoperative day 1 pain scores(3.1 vs.3.3),overall incidence of complications(25.5%vs.38.0%),and incidence of abnormal skin sensations(5.1%vs.24.0%

关 键 词：静脉曲张 隐静脉 射频消融术 结扎术 

分 类 号：R654.3[医药卫生—外科学]