Guo Zhenyu, Li Xu, Wang Tao, Yang Xiaohu, Wang Chen, Fan Longhua
Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, affiliated to Fudan University, Shanghai 201700, China.
Department of Vascular Surgery, Zhongshan Hospital, affiliated to Fudan University, Shanghai 200032, China.
Surgery. 2022 May;171(5):1427-1433. doi: 10.1016/j.surg.2021.10.048. Epub 2021 Nov 22.
This study aimed to investigate the clinical results of endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins based on diabetic management.
The study reviewed 501 patients who underwent endovenous thermal ablation combined with stab phlebectomy for unilateral varicose veins, including 337 nondiabetics (control group) and 164 diabetics. Diabetics with hemoglobin A1c ≥7% were classified as the poor glycemic control group, and hemoglobin A1c <7% as the good glycemic control group. Surgical outcomes were assessed by Venous Clinical Severity Score. The Chronic Venous disease quality of life Questionnaire was used to assess the quality of life.
Lower limb varicose veins can be treated successfully with endovenous thermal ablation combined with stab phlebectomy in patients with or without poor glycemic control, accompanied by a significant improvement in health status. For patients with initial varicose veins (preoperative Venous Clinical Severity Score <10), the results revealed satisfactory improvements in Venous Clinical Severity Score and quality of life among the control, poor glycemic control, and good glycemic control groups. Patients with advanced varicose veins (preoperative Venous Clinical Severity Score ≥10) also showed an obvious amelioration concerning venous symptoms and quality of life. However, the extent of improvement varied among the 3 groups. Patients subjected to advanced varicose veins with the condition of poor glycemic control exhibited a less desirable improvement in postoperative health conditions compared with the control and good glycemic control groups, especially in edema relief and ulcer healing.
Endovenous thermal ablation combined with stab phlebectomy is safe and effective in the treatment of varicose veins with or without poor glycemic control. Clinical attempts at hemoglobin A1c management may contribute to improved clinical outcomes in patients with advanced varicose veins.
本研究旨在探讨基于糖尿病管理的静脉内热消融联合小切口静脉切除术治疗单侧静脉曲张的临床效果。
本研究回顾了501例行静脉内热消融联合小切口静脉切除术治疗单侧静脉曲张的患者，其中337例非糖尿病患者（对照组）和164例糖尿病患者。糖化血红蛋白A1c≥7%的糖尿病患者被归类为血糖控制不佳组，糖化血红蛋白A1c<7%的患者为血糖控制良好组。采用静脉临床严重程度评分评估手术效果。使用慢性静脉疾病生活质量问卷评估生活质量。
无论血糖控制是否不佳，静脉内热消融联合小切口静脉切除术均可成功治疗下肢静脉曲张，同时健康状况显著改善。对于初始静脉曲张患者（术前静脉临床严重程度评分<10），结果显示对照组、血糖控制不佳组和血糖控制良好组的静脉临床严重程度评分和生活质量均有令人满意的改善。晚期静脉曲张患者（术前静脉临床严重程度评分≥10）的静脉症状和生活质量也有明显改善。然而，三组之间的改善程度有所不同。与对照组和血糖控制良好组相比，血糖控制不佳的晚期静脉曲张患者术后健康状况改善较差，尤其是在水肿缓解和溃疡愈合方面。
静脉内热消融联合小切口静脉切除术治疗血糖控制不佳或良好的静脉曲张均安全有效。对糖化血红蛋白进行临床管理的尝试可能有助于改善晚期静脉曲张患者的临床结局。
