Khryshchanovich V Ya, Shestak N G, Skobeleva N Ya
Belarussian State Medical University, Minsk, Republic of Belarus.
Savchenko Minsk City Clinical Hospital No. 4, Minsk, Republic of Belarus.
Khirurgiia (Mosk). 2022(6):116-126. doi: 10.17116/hirurgia2022061116.
To compare the outcomes of thermal and mechanochemical endovenous ablative techniques in patients with varicose veins.
We searched the PubMed, EMBASE and Cochrane Library databases for studies devoted to mechanochemical and thermal endovenous ablative techniques from inception until July 2021. The primary outcome was anatomical success. Secondary endpoints were intraoperative pain syndrome, complications, modification of disease severity and quality of life.
This meta-analysis enrolled 10 comparative studies and 1.252 participants after truncal ablations. The follow-up period ranged from 4 weeks to 36 months. With regard to overall anatomical success, 245 out of 267 (91.8%) patients after mechanochemical ablation and 249 out of 266 (93.6%) patients after thermal ablation had favorable results after a month (low-quality evidence; odds ratio [OR] 0.79; 95% CI 0.40-1.55). No statistical heterogeneity was identified (χ=1.48; df=2; =0.48; I=0%). Further analysis identified different incidence of total occlusion after 12 months or later (OR 0.36; 95% CI 0.11-1.21; =0.05; I=68%). Mechanochemical ablation resulted less intraoperative pain. Mean difference was -1.3 (95% CI -2.53- -0.07; =0.00001). MOCA was followed by fewer incidence of nerve injury, hematoma, deep vein thrombosis and phlebitis. There were more cases of skin pigmentation compared to thermal ablation (low-quality evidence, >0.05). Subsequent assessment of disease severity identified significant between-group difference of means (-0.64 (95% CI -1.82-0.53; =0.004) and -0.16 (95% CI -0.43-0.11; =0.005) after 6 and 12 months, respectively). Further assessment of quality of life revealed no between-group differences. These data were characterized by moderate methodological quality.
Mechanochemical ablation is as effective as standard TA within the first postoperative month. However, this approach is associated with lesser anatomical success after 12 months. In most studies, pain syndrome was less severe in case of mechanochemical ablation. These data suggest that mechanochemical ablation is a safe alternative for varicose veins. However, further large-scale trials are required to define the role of MOCA.
比较热消融和机械化学性静脉内消融技术治疗静脉曲张患者的疗效。
我们检索了PubMed、EMBASE和Cochrane图书馆数据库，查找从建库至2021年7月期间有关机械化学性和热静脉内消融技术的研究。主要结局为解剖学成功。次要终点为术中疼痛综合征、并发症、疾病严重程度的改变和生活质量。
这项荟萃分析纳入了10项比较研究，共1252例接受主干消融的参与者。随访期为4周36个月。关于总体解剖学成功情况，机械化学消融术后267例患者中有245例（91.8%）、热消融术后266例患者中有249例（93.6%）在1个月后取得了良好效果（低质量证据；比值比[OR]0.79；95%可信区间[CI]0.401.55）。未发现统计学异质性（χ²=1.48；自由度=2；P=0.48；I²=0%）。进一步分析发现，12个月及以后完全闭塞的发生率不同（OR 0.36；95%CI 0.111.21；P=0.05；I²=68%）。机械化学消融导致的术中疼痛较轻。平均差值为-1.3（95%CI -2.53-0.0-7；P=0.00001）。与热消融相比，机械化学消融术后神经损伤、血肿、深静脉血栓形成和静脉炎的发生率更低。皮肤色素沉着的病例比热消融更多（低质量证据，P>0.05）。随后对疾病严重程度的评估发现，术后6个月和12个月时组间均值存在显著差异（分别为-0.64（95%CI -1.820.53；P=0.004）和-0.16（95%CI -0.430.11；P=0.005））。对生活质量的进一步评估显示组间无差异。这些数据的方法学质量为中等。
机械化学消融在术后第一个月内与标准热消融效果相当。然而，这种方法在12个月后解剖学成功率较低。在大多数研究中，机械化学消融时疼痛综合征较轻。这些数据表明，机械化学消融是治疗静脉曲张的一种安全替代方法。然而，需要进一步的大规模试验来确定机械化学消融的作用。
