一并解除髂静脉压迫对大隐静脉曲张手术预后的影响:一项倾向性评分匹配研究  

Impact of concurrent iliac vein compression relief on surgical outcomes for great saphenous vein varicosities:A propensity score-matched study

作　　者：甘茂 张伟[1,2] 王哲[1,2] 何林祥 叶小萍[3] 赵渝[1,2] 刘洪[1,2] GAN Mao;ZHANG Wei;WANG Zhe;HE Linxiang;YE Xiaoping;ZHAO Yu;LIU Hong(Department of Vascular Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China;Day Surgery Center,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China;Department of Ultrasound,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China)

机构地区：[1]重庆医科大学附属第一医院血管外科,重庆400016 [2]重庆医科大学附属第一医院日间服务中心,重庆400016 [3]重庆医科大学附属第一医院超声科,重庆400016

出　　处：《中国普外基础与临床杂志》2025年第4期422-427,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：重庆市科卫联合医学科研项目(项目编号:2022MSXM077);重庆医科大学未来医学青年创新团队支持计划(项目编号:W0191)。

摘　　要：目的比较合并髂静脉压迫(iliac vein compression,IVC)的大隐静脉曲张患者单纯治疗静脉曲张与一并处理IVC在改善下肢症状及预后方面的疗效。方法根据纳入和排除标准回顾性收集2022年5月至2025年1月期间于重庆医科大学附属第一医院日间服务中心收治的大隐静脉曲张合并IVC的患者,根据治疗策略不同分为单纯治疗静脉曲张组(对照组)和一并治疗静脉曲张和IVC组(观察组),主要研究终点包括术后6个月及12个月时2组大隐静脉主干闭合率、静脉临床严重程度评分(venous clinical severity score,VCSS)及静脉功能不全患者生活质量/症状问卷(venous insufficiency epidemiological and economic study quality of life/symptom,VEINES-QOL/Sym)调查评分。检验水准α=0.05。结果本研究共纳入264例左侧大隐静脉曲张合并IVC患者,其中观察组32例患者,在剩余232例患者中采用倾向性评分匹配方法为观察组按1∶3比例匹配对照组患者,对照组纳入96例患者。2组患者在性别、年龄、基础疾病等基线特征方面比较差异均无统计学意义(P>0.05)。术后12个月时,2组患者大隐静脉主干闭合率均达100%。2组患者组内变化,术后6及12个月时VCSS及VEINES-QOL/Sym评分均较术前(入院时)明显改善(P<0.05)。组间变化,术后6个月时观察组在VEINES-QOL/Sym评分较对照组改善明显(P=0.028),VCSS变化不明显(P=0.775);在术后12个月时,观察组VCSS(P<0.001)及VEINESQOL/Sym评分(P<0.001)均明显优于对照组。结论对于合并IVC的左侧大隐静脉曲张患者,无论采用单纯治疗静脉曲张或一并处理IVC均可显著改善患者下肢症状。短期随访(6个月)显示一并处理IVC对患者生活质量改善在早期即已显现出优势,继续随访至12个月时一并处理IVC可获得更优的下肢症状改善和生活质量改善效果。提示对于合并IVC的大隐静脉曲张患者,IVC一并处理可能在中长期预后方面具有更大优势。Objective To compare the efficacy of varicose great saphenous vein(GSV)treatment alone versus combined treatment with iliac vein compression(IVC)intervention in improving lower extremity symptoms and prognosis among the patients with varicose GSV complicated by IVC.Methods Based on inclusion and exclusion criteria,the patients with varicose GSV complicated by IVC treated at the Day Service Center of the First Affiliated Hospital of Chongqing Medical University from May 2022 to January 2025 were retrospectively enrolled.The patients were assigned into two groups according to the treatment strategies:the varicose GSV treatment alone group(control group)and the combined treatment group for varicose GSV and IVC(observation group).The primary endpoints included the closure rate of the GSV trunk,venous clinical severity score(VCSS),and venous insufficiency epidemiological and economic study quality of life/symptom(VEINES-QOL/Sym)questionnaire score at 6 and 12 months postoperatively.The significance level was set atα=0.05.Results A total of 264 patients with left lower extremity varicose GSV complicated by IVC were included.The observation group comprised 32 patients,while the remaining 232 patients underwent 1∶3 propensity score-matching,resulting in 96 matched patients in the control group.The baseline characteristics,including gender,age,and comorbidities,showed no statistically significant differences between the two groups(P>0.05).At 12 months postoperatively,the GSV trunk closure rate was 100%in both groups.Within-group comparisons revealed significant improvements in the VCSS and VEINES-QOL/Sym points at 6 and 12 months as compared with preoperative(on admission)values(P<0.05).Between-group comparisons showed that the observation group had greater improvement in the VEINES-QOL/Sym score at 6 months(P=0.028),but no significant difference in the VCSS(P=0.775);At 12 months,the observation group demonstrated significantly better the VCSS(P<0.001)and VEINES-QOL/Sym points(P<0.001)as compared with the control group

关 键 词：髂静脉压迫 下肢静脉曲张 腔内治疗 倾向性评分匹配 

分 类 号：R654.3[医药卫生—外科学]