作者：李志刚1，孙默2，何楠3，兰勇4

单位：

1.100035北京市，北京中医药大学附属护国寺中医医院血管外科　2.100035北京市，北京中医药大学附属护国寺中医医院老年病科3.100029北京市，首都医科大学附属北京安贞医院血管外科　4.100730北京市，北京医院血管外科

Units：

1.Vascular Surgery, Huguosi Hospital of Traditional Chinese Medicine Affiliated to Beijing University of Traditional ChineseMedicine, Beijing 100035, China2.Department of Geriatrics, Huguosi Hospital of Traditional Chinese Medicine Affiliated to Beijing University of TraditionalChinese Medicine, Beijing 100035, China3.Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China4.Vascular Surgery, Beijing Hospital, Beijing 100730, China

关键词：

静脉曲张；原发性大隐静脉曲张；射频消融术；硬化溶剂；高位结扎剥脱术；血液流变学；炎症因子

Keywords：

Varicose veins; Primary great saphenous vein varicose; Radiofrequency ablation; Sclerosing solutions;High ligation and stripping; Hemorheology; Inflammatory factor

CLC：

R 543.6

DOI：

10.12114/j.issn.1008-5971.2022.00.255

Funds：

国家自然科学基金资助项目（31371160）

摘要：

目的　探讨大隐静脉主干射频消融术（RFA）+小腿段曲张静脉泡沫硬化剂注射治疗老年原发性大隐静脉曲张患者的疗效。方法　选取2017年10月至2020年3月北京中医药大学附属护国寺中医医院收治的260例老年原发性大隐静脉曲张患者为研究对象，采用随机数字表法分为观察组和对照组，每组130例。对照组患者采用高位结扎剥脱术治疗，观察组患者采用大隐静脉主干RFA+小腿段曲张静脉泡沫硬化剂注射治疗。比较两组术后3个月临床疗效，手术时间、住院时间、术中出血量、术前及术后12 h心率、术前及术后12 h平均动脉压（MAP）、术后7 d视觉模拟评分法（VAS）评分，术前及术后3个月血液流变学指标（血浆黏度、纤维蛋白原、低切全血黏度）、炎性指标〔基质金属蛋白酶13（MMP-13）、肿瘤坏死因子α（TNF-α）、IL-6、IL-17〕，并发症发生率，随访12个月记录患者复发情况。结果　观察组治疗总有效率为95.38%（124/130），高于对照组的84.62%（110/130）（χ2=8.376，P =0.004）。观察组手术时间、住院时间短于对照组，术中出血量少于对照组，术后7 d VAS评分低于对照组（P ＜0.05）。术后3个月两组血浆黏度、纤维蛋白原、低切全血黏度、MMP-13、TNF-α、IL-6、IL-17分别低于本组术前，且观察组血浆黏度、纤维蛋白原、低切全血黏度、MMP-13、TNF-α、IL-6、IL-17低于对照组（P ＜0.05）。观察组并发症总发生率为8.46%（11/130），低于对照组的22.31%（29/130）（χ2=9.573，P =0.002）。随访12个月，观察组复发率为2.31%（3/130），与对照组的4.62%（6/130）比较，差异无统计学意义（χ2=0.460，P =0.497）。结论　大隐静脉主干RFA+小腿段曲张静脉泡沫硬化剂注射可提高老年原发性大隐静脉曲张患者治疗效果，明显缩短手术时间、住院时间，减少术中出血量，减轻疼痛程度，并能改善血液流变学指标及炎性指标，降低并发症发生率。

Abstract：

Objective　To investigate the efficacy of radiofrequency ablation (RFA) of the main trunk of the greatsaphenous vein combined with injection of foam sclerosing agent into calf varicose vein in the treatment of elderly patients with primary great saphenous vein varicose. Methods　A total of 260 elderly patients with primary great saphenous vein varicose inHuguosi Hospital of Traditional Chinese Medicine Affiliated to Beijing University of Traditional Chinese Medicine from October2017 to March 2020 were selected as the study subjects. They were divided into control group and observation group by randomnumber table method, 130 cases in each group. The control group was treated with high ligation and stripping, and the observationgroup was treated with RFA of the main trunk of the great saphenous vein combined with injection of foam sclerosing agent intocalf varicose vein. The clinical efficacy 3 months after operation, operation time, hospitalization time, intraoperative blood loss,heart rate and mean arterial pressure (MAP) before operation and 12 h after operation, Visual Analogue Scale (VAS) score 7 dafter operation, hemorheology indexes (plasma viscosity, fibrinogen, low shear whole blood viscosity) and inflammatory indexes[matrix metalloproteinase-13 (MMP-13) , tumor necrosis factor-α (TNF-α) , IL-6, IL-17] before operation and 3 months afteroperation, complication rate of the two groups were compared. The patients were followed up for 12 months and the recurrenceof patients was recorded. Results　After treatment, the total effective rate of the observation group [95.38% (124/130) ] washigher than that of the control group [84.62% (110/130) ] (χ2=8.376, P =0.004) . The operation time, hospitalization time inobservation group were shorter than those in the control group, intraoperative blood loss in observation group was less than thatin the control group, VAS score 7 d after operation in observation group was lower than that in the control group (P < 0.05) . Theplasma viscosity, fibrinogen, low shear whole blood viscosity, MMP-13, TNF-α, IL-6, IL-17 3 months after operation in thecontrol group and observation group were lower than those before operation, respectively, and the plasma viscosity, fibrinogen, lowshear whole blood viscosity, MMP-13, TNF-α, IL-6, IL-17 in the observation group were lower than those in the control group(P < 0.05) . The complication rate of the observation group [8.46% (11/130) ] was lower than that of the control group [22.31%(29/130) ] (χ2=9.573, P =0.002) . After 12 months of follow-up, there was no significant difference in recurrence rate between theobservation group [2.31% (3/130) ] and the control group [4.62% (6/130) ] (χ2=0.460, P =0.497) . Conclusion　RFA of the maintrunk of the great saphenous vein combined with injection of foam sclerosing agent into calf varicose vein can significantly improvethe therapeutic effect of elderly patients with primary great saphenous vein varicose, shorten the operation time and hospitalizationtime, reduce the intraoperative blood loss and degree of pain after operation, improve the hemorheology indexes and inflammatoryindexes, and reduce the incidence of complications.

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