Li Qiang, Zhang Chen, Yuan Zhao, Shao Zi-Qi, Wang Jian
Department of General Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China.
World J Clin Cases. 2023 Dec 16;11(35):8291-8299. doi: 10.12998/wjcc.v11.i35.8291.
Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. Previous studies comparing endovenous laser treatment (EVLT) and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors. In this study, we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.
To compare the perioperative and postoperative outcomes of EVLT and conventional surgery in patients with great saphenous vein varicosis.
We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019. Among them, 56 patients were excluded owing to additional small saphenous varicose vein involvement, 81 owing to recurring varicose veins, 83 owing to complicated varicose veins (CEAP clinical classification C5-C6), and 6 owing to perioperative phlebitis. Finally, 772 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from the medical records of the patients. For propensity score matching, 522 patients (261 who underwent EVLT and 261 who underwent conventional surgery) were randomly matched 1:1 by age, sex, onset time, smoking status, presence of diabetes, family history, stress therapy, C class, and the affected leg.
Of the 772 patients included in the study, 467 underwent EVLT and 305 underwent conventional surgery. There were significant differences in age, onset time, smoking and diabetes status, and family history between the two groups. Following propensity score matching, no significant differences in patients' characteristics remained between the two groups. ELVT was associated with a shorter operation time and hospital stay than conventional surgery, both before and after propensity score matching. There were no differences in complications between the two groups after propensity score matching. Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery (33.33% 21.46%, = 11.506, = 0.001), and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure (39.85% 19.54%, = 0.000).
EVLT may not always be the best option for the treatment of great saphenous vein varicosis.
静脉曲张是一种常见的静脉疾病，通常采用手术治疗。然而，选择最佳手术方法可能具有挑战性。以往比较腔内激光治疗（EVLT）和传统手术的研究本质上是回顾性和观察性的，因此结果可能受到选择偏倚和其他混杂因素的影响。在本研究中，我们在比较EVLT和传统手术治疗大隐静脉曲张时，使用倾向评分匹配来减少选择偏倚。
比较EVLT和传统手术治疗大隐静脉曲张患者的围手术期和术后结果。
我们回顾性分析了徐州医科大学第二附属医院2009年1月至2019年12月期间1063例接受大隐静脉原发性静脉曲张治疗患者的记录。其中，56例因合并小隐静脉曲张被排除，81例因静脉曲张复发被排除，83例因复杂性静脉曲张（CEAP临床分级C5 - C6）被排除，6例因围手术期静脉炎被排除。最终，772例患者纳入本研究。从患者病历中收集标准的人口统计学和临床病理数据。对于倾向评分匹配，522例患者（261例行EVLT，261例行传统手术）按年龄、性别、发病时间、吸烟状况、糖尿病史、家族史、压力治疗、C级和患侧腿进行1:1随机匹配。
在纳入研究的772例患者中，467例行EVLT，305例行传统手术。两组在年龄、发病时间、吸烟和糖尿病状况以及家族史方面存在显著差异。倾向评分匹配后，两组患者特征无显著差异。在倾向评分匹配前后，EVLT的手术时间和住院时间均比传统手术短。倾向评分匹配后两组并发症无差异。在两年随访期内，接受EVLT的患者复发率高于接受传统手术的患者（33.33%对21.46%，χ² = 11.506，P = 0.001），且接受EVLT的患者术后一周疼痛发生率更高（分别为39.85%和19.54%，P = 0.000）。
EVLT可能并非总是治疗大隐静脉曲张的最佳选择。
