Darwood R J, Gough M J
Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, UK.
Phlebology. 2009;24 Suppl 1:50-61. doi: 10.1258/phleb.2009.09s006.
Endovenous laser ablation (EVLA) of incompetent truncal veins has been proposed as a minimally invasive alternative to conventional surgery for varicose veins. Various strategies have been proposed for successful treatment and this study reviews the evidence for these.
A Medline and 'controlled trials online database' search was performed to identify original articles and randomized controlled trials (RCTs) reporting outcomes for EVLA. Information on patient selection, equipment, technique and outcomes were recorded.
Ninety-eight original studies, including five RCTs, were identified. RCT data indicate short-term outcomes (abolition of reflux, improvement in quality of life [QOL], patient satisfaction) were equivalent to those for surgery. Long-term follow-up is not available. A further RCT showed superior outcomes for ablation commencing at the lowest point of superficial venous reflux rather than at an arbitrary point (fewer residual varicosities, greater improvement in QOL). Non-randomized series suggest that laser energy of >60 J/cm results in reliable truncal vein occlusion and that longer wavelength lasers may be associated with less post-treatment discomfort.
In the short-term EVLA is a safe and effective treatment for patients with varicose veins. Long-term follow-up is still required.
对于功能不全的主干静脉，腔内激光消融术（EVLA）已被提议作为治疗静脉曲张的传统手术的一种微创替代方法。为实现成功治疗，人们提出了各种策略，本研究对这些策略的证据进行了综述。
通过检索医学文献数据库（Medline）和“在线对照试验数据库”，以识别报告腔内激光消融术结果的原始文章和随机对照试验（RCT）。记录有关患者选择、设备、技术和结果的信息。
共识别出98项原始研究，其中包括5项随机对照试验。随机对照试验数据表明，短期结果（反流消失、生活质量[QOL]改善、患者满意度）与手术相当。尚无长期随访数据。另一项随机对照试验表明，从浅静脉反流最低点而非任意点开始消融效果更佳（残留静脉曲张更少、生活质量改善更大）。非随机系列研究表明，激光能量>60 J/cm可导致可靠的主干静脉闭塞，且波长较长的激光可能与治疗后不适较少有关。
短期内，腔内激光消融术是治疗静脉曲张患者的一种安全有效的方法。仍需进行长期随访。
