探讨腔内射频消融联合泡沫硬化剂治疗下肢原发性大隐静脉曲张的临床治疗效果。

采用回顾性病例对照研究分析2016年6月至2018年12月东南大学附属徐州医院(徐州市中心医院)血管外科收治的520例原发性大隐静脉曲张患者，其中男性300例，女性220例；年龄30～80岁，平均(60±2)岁。研究组共纳入260例经腔内射频消融联合泡沫硬化剂注射治疗的原发性大隐静脉曲张患者，共320条肢体，所有患者在彩色多普勒超声引导下对大隐静脉主干予以射频消融闭合。同时联合小腿段曲张静脉及交通支点状剥脱和泡沫硬化剂应用进行治疗。同期260例接受传统手术的大隐静脉曲张患者作为对照组。比较两组手术时间、术中出血量、术后早期下床活动时间、住院时间、术后疼痛评分以及隐神经损伤、切口感染、深静脉血栓形成、血肿等并发症的发生率，同时对两组患者进行随访，比较两组术后生活质量、术后6个月和12个月大隐静脉主干闭合情况以及1年下肢静脉曲张复发率。

研究组手术时间(30.0±3.6)min比对照组(60.4±5.9)min、出血量(20.3±4.6)mL比对照组出血量(80.0±3.2)mL、术后早期下床活动时间(1.0±0.3)h比对照组(6.3±2.0)h、住院时间(2.0±0.8)d比对照组(7.5±1.2)d、术后疼痛评分(3.2±0.3)分比对照组(5.4±1.2)分以及隐神经损伤率0(0/260)比对照组2.3%(6/260)、切口感染0(0/260)比对照组3.0%(8/260)、深静脉血栓形成率0(0/260)比对照组1.9%(5/260)、大腿段血肿发生率0(0/260)比对照组6.9%(18/260)均低于传统手术组，生活质量评分(56.78±3.21)也较对照组术后(42.23±2.81)明显改善，差异均有统计学意义(P均<0.05)。术后随访结果显示：6个月时，研究组有3例患者大隐静脉主干出现部分血流；12个月时为5例。但血液返流到大腿中段即消失，小腿段未见明显曲张血管。而对照组6个月和12个月时的大隐静脉再通率分别为1.5%(4/260)和1.9%(5/260)，但两组患者术后1年的下肢静脉曲张复发率的差异无统计学意义(P>0.05)。

腔内射频消融联合泡沫硬化剂注射对原发性大隐静脉曲张的疗效肯定，短期及中期效果好，为日间手术提供一种较好的模式。

To investigate the clinical effect of endo-venous radiofrequency ablation combined with foam sclerotherapy in the treatment of great saphenous vein of varicose of the lower limbs.

The clinical data of 520 patients with primary saphenous varices admitted to Xuzhou Central Hospital from June 2016 to December 2018 were retrospectively analyzed, including 300 males and 220 females, aged 30-80 years with an average age of (60 ± 2) years. The study group included 260 patients(320 limbs) who underwent endo-venous radiofrequency ablation combined with foam sclerotherapy and compared them with 260 patients with saphenous varices who underwent conventional surgery. The operation time, intraoperative blood loss, postoperative activity out of bed days, hospitalization time, and the incidence of postoperative pain, saphenous nerve injury, wound infection, deep vein thrombosis, and hematoma were compared between the two groups. The postoperative quality of life, the closure of the saphenous vein in the 6th and 12th months after surgery, and the recurrence rate within 1 year were compared by follow-up.

The operation time between the study group and the control group was (30.0±3.6) min vs. (60.4±5.9) min, intraoperative blood loss was (20.3±4.6) mL vs. (80.0±3.2) mL, postoperative activity out of bed days was (1.0±0.3)h vs.(6.3±2.0)h, hospitalization time was (2.0±0.8)d vs.(7.5±1.2)d, postoperative pain score was (3.2±0.3) vs.(5.4±1.2), saphenous nerve injury was 0 (0/260) vs. 2.3% (6/260), wound infection was 0 (0/260) vs. 3.0% (8/260), deep vein thrombosis rate was 0 (0/260) vs. 1.9% (5/260), the incidence of thigh hematoma was 0 (0/260) vs. 6.9% (18/260), and the quality of life score was (56.78±3.21) vs. (42.23±2.81); the difference between the two groups was statistically significant (P<0.05). The follow-up results showed that there were 3 cases and 5 cases of partial saphenous vein in the study group at 6 months and 12 months after operation, but in the control group, the recanalization rates of saphenous vein at 6 months and 12 months were 1.5% (4/260) and 1.9% (5/260), respectively. There was no significant difference in the recurrence rate of varicose veins between the two groups (P>0.05).

Radiofrequency ablation combined with foam sclerotherapy has a positive effect on primary saphenous vein varices, and it has good short-term and long-term effects, which can provide a better model for daytime surgery.