Vascular Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
The University of Sheffield, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Eur J Vasc Endovasc Surg. 2023 Nov;66(5):687-695. doi: 10.1016/j.ejvs.2023.06.002. Epub 2023 Jun 7.
The objective was to compare technical success, complications, and quality of life after thermal vs. non-thermal endovenous ablation for the treatment of superficial venous incompetence.
Electronic bibliographic sources (Google Scholar, Pubmed, Cochrane Database, Scopus, Web of Science, and Embase).
A systematic review and meta-analysis of randomised controlled trials was conducted using terms to identify relevant studies to be included. The primary outcome was vein occlusion rate at up to four weeks and one to two years from procedure. Secondary outcome measures included peri-procedural pain, nerve injury, endothermal heat induced thrombosis, and quality of life.
Eight randomised controlled trials met the selection criteria. These comprised a total of 1 956 patients, of whom 1 042 underwent endovenous thermal ablation and 915 underwent endovenous non-thermal ablation. There was no statistically significant difference in occlusion rate at all time points. Relative risk at four weeks and one to two years was 0.99 (95% CI 0.96 - 1.02) and 0.95 (95% CI 0.88 - 1.01), respectively. Non-thermal ablation was tolerated better and had less risk of nerve injury. There was no statistically significant difference in risk of endothermal heat induced thrombosis (EHIT). There was improvement in quality of life scores post-procedure but there was no statistically significant difference in thermal vs. non-thermal ablation. The quality of evidence assessed using GRADE methodology showed high quality for occlusion rate at four weeks and one to two years, moderate quality for nerve injury and peri-procedural pain, and low quality for EHIT.
Vein occlusion rates after thermal vs. non-thermal endovenous ablation are similar. In the early post-operative period, non-thermal endovenous ablation demonstrated the advantages of less pain and less risk of nerve injury. Improvement in quality of life after both thermal and non-thermal endovenous ablation is similar.
比较热与非热静脉内消融治疗浅静脉功能不全的技术成功率、并发症和生活质量。
电子文献数据库（Google Scholar、Pubmed、Cochrane 数据库、Scopus、Web of Science 和 Embase）。
通过使用特定术语对相关研究进行系统检索和荟萃分析，以确定纳入的研究。主要结局指标是术后 4 周和 1 至 2 年内静脉闭塞率。次要结局指标包括围手术期疼痛、神经损伤、热诱导血栓形成和生活质量。
8 项随机对照试验符合入选标准。这些试验共纳入 1956 例患者，其中 1042 例接受静脉内热消融治疗，915 例接受静脉内非热消融治疗。所有时间点的闭塞率均无统计学差异。4 周和 1 至 2 年的相对风险分别为 0.99（95%CI 0.96-1.02）和 0.95（95%CI 0.88-1.01）。非热消融治疗耐受性更好，神经损伤风险较低。热诱导血栓形成（EHIT）风险无统计学差异。术后生活质量评分有所改善，但热与非热消融治疗之间无统计学差异。使用 GRADE 方法评估的证据质量显示，4 周和 1 至 2 年的闭塞率为高质量，神经损伤和围手术期疼痛为中质量，EHIT 为低质量。
热与非热静脉内消融治疗后静脉闭塞率相似。在术后早期，非热静脉内消融治疗具有疼痛较轻和神经损伤风险较低的优势。热与非热静脉内消融治疗后生活质量的改善相似。
