Guo Liqin, Huang Rong, Zhao Dunyong, Xu Guilian, Liu Hui, Yang Jian, Guo Tao
School of Nursing, Huanggang Polytechnic College, Huanggang.
Institute of Digestive, Southwest Hospital, Third Military Medical University, Chongqing.
Medicine (Baltimore). 2019 Feb;98(7):e14495. doi: 10.1097/MD.0000000000014495.
Various procedures for the treatment of varicose veins have been shown to have long-term effectiveness, but research has yet to identify the most effective procedure. The aim of this study was to investigate the long-term efficacy of different procedures based on Bayesian network meta-analysis and to rank therapeutic options for clinical decision-making.
Globally recognized databases, namely, MEDLINE, Embase, and Cochrane Central, were searched for randomized controlled trials (RCTs). Quantitative pooled estimation of successful treatment rate (STR) and recurrence rate (RR) was performed to assess the long-term efficacy of each procedure with more than a 1-year follow-up. The surface under the cumulative ranking (SUCRA) probabilities of the P values regarding STR and RR were calculated to rank various procedures. Grades of Recommendations Assessment, Development and Evaluation (GRADE) criteria were utilized for the recommendation of evidence from pairwise direct comparisons.
A total of 39 RCTs encompassing a total of 6917 limbs were eligible and provided relative raw data. After quantitative analysis, the CHIVA procedure was determined to have the best long-term efficacy, as it had the highest STR (SUCRA, 0.37). Additionally, the results revealed that CHIVA possessed the highest probability of achieving the lowest long-term RR (SUCRA, 0.61). Moreover, the sensitivity analysis with inconsistency approach clarified the reliability of the main results, and the evidence of most direct comparisons was ranked as high or moderate.
CHIVA seemed to have superior clinical benefits on long-term efficacy for treating varicose veins. However, the conclusion still needs additional trials for supporting evidence.
各种治疗静脉曲张的手术已被证明具有长期疗效，但尚未确定最有效的手术方式。本研究旨在基于贝叶斯网络荟萃分析探讨不同手术的长期疗效，并对治疗方案进行排序以辅助临床决策。
检索全球知名数据库，即MEDLINE、Embase和Cochrane Central，查找随机对照试验（RCT）。对成功治疗率（STR）和复发率（RR）进行定量汇总估计，以评估每种随访时间超过1年的手术的长期疗效。计算STR和RR的P值的累积排序曲线下面积（SUCRA）概率，对各种手术进行排序。采用推荐分级的评估、制定与评价（GRADE）标准对两两直接比较的证据进行推荐。
共有39项RCT符合纳入标准，涉及6917条肢体，并提供了相关原始数据。定量分析后，CHIVA手术被确定具有最佳的长期疗效，因为它具有最高的STR（SUCRA，0.37）。此外，结果显示CHIVA实现最低长期RR的概率最高（SUCRA，0.61）。而且，采用不一致性方法的敏感性分析明确了主要结果的可靠性，大多数直接比较的证据被评为高或中等。
CHIVA在治疗静脉曲张的长期疗效方面似乎具有更好的临床效益。然而，该结论仍需更多试验来提供支持证据。
