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首页> 外文期刊>Sao Paulo Medical Journal >Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices
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Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices

机译：静脉内消融（射频和激光）和泡沫硬化疗法与常规手术相比，隐静脉曲张大

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BACKGROUND: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with conventional surgery (high ligation and stripping (HL/S)), proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL) scores, reduced need for general anaesthesia and equivalent recurrence rates. OBJECTIVE : To review available randomized controlled clinical trials (RCT) data comparing USGFS, RFA, EVLT to HL/S for the treatment of great saphenous varicose veins. METHODS : Search methods: The Cochrane Peripheral Vascular Diseases (PVD) Group searched their Specialized Register (July 2010) and CENTRAL (The Cochrane Library 2010, Issue 3). In addition the authors performed a search of EMBASE (July 2010). Manufacturers of EVLT, RFA and sclerosant equipment were contacted for trial data. Selection criteria: All RCTs of EVLT, RFA, USGFS and HL/S were considered for inclusion. Primary outcomes were recurrent varicosities, recanalization, neovascularization, technical procedure failure or need for re-intervention, patient quality of life (QoL) scores and associated complications. Secondary outcomes were type of anaesthetic, procedure duration, hospital stay and cost. Data collection and analysis: CN, RE, VB, PC, HB and GS independently reviewed, assessed and selected trials which met the inclusion criteria. CN and RE extracted data. The Cochrane Collaboration's tool for assessing risk of bias was used. CN contacted trial authors to clarify details. MAIN RESULTS: Thirteen reports from five studies with a combined total of 450 patients were included. Rates of recanalization were higher following EVLT compared with HL/S, both early (within four months) (5/149 versus 0/100; odds ratio (OR) 3.83, 95% confidence interval (CI) 0.45 to 32.64) and late recanalization (after four months) (9/118 versus 1/80; OR 2.97; 95% CI 0.52 to 16.98), although these results were not statistically significant. Technical failure rates favoured EVLT over HL/S (1/149 versus 6/100; OR 0.12, 95% CI 0.02 to 0.75). Recurrence following RFA showed no difference when compared with surgery. Recanalization within four months was observed more frequently following RFA compared with HL/S although not statistically significant (4/105 versus 0/88; OR 7.86, 95% CI 0.41 to 151.28); after four months no difference was observed. Neovascularization was observed more frequently following HL/S compared with RFA, but again this was not statistically significant (3/42 versus 8/51; OR 0.39, 95% CI 0.09 to 1.63). Technical failure was observed less frequently following RFA compared with HL/S although this was not statistically significant (2/106 versus 7/96; OR 0.48, 95% CI 0.01 to 34.25). No randomised clinical trials comparing HL/S versus USGFS met our study inclusion criteria. QoL scores and operative complications were not amenable to meta-analysis. AUTHORS' CONCLUSIONS: Currently available clinical trial evidence suggests RFA and EVLT are at least as effective as surgery in the treatment of great saphenous varicose veins. There are insufficient data to comment on USGFS. Further randomized trials are needed. We should aim to report and analyze results in a congruent manner to facilitate future meta-analysis.
机译：背景：用于治疗大隐静脉曲张的微创技术包括超声引导的泡沫硬化疗法（USGFS），射频消融（RFA）和静脉激光疗法（EVLT）。与常规手术（高结扎和剥离（HL / S））相比，拟议的好处包括并发症更少，恢复工作更快，生活质量（QoL）评分提高，全身麻醉的需求减少和复发率相同。目的：回顾比较USGFS，RFA，EVLT与HL / S治疗大隐静脉曲张的可用随机对照临床试验（RCT）数据。方法：搜索方法：Cochrane周围血管疾病（PVD）组搜索了他们的专业注册（2010年7月）和CENTRAL（Cochrane图书馆2010年第3期）。此外，作者对EMBASE进行了搜索（2010年7月）。联系了EVLT，RFA和硬化剂设备的制造商以获取试验数据。选择标准：EVLT，RFA，USGFS和HL / S的所有RCT均纳入考虑范围。主要结果是复发性静脉曲张，再通，新血管形成，技术程序失败或需要再次干预，患者生活质量（QoL）评分及相关并发症。次要结果是麻醉剂的类型，手术时间，住院时间和费用。数据收集和分析：CN，RE，VB，PC，HB和GS独立审查，评估和选择符合纳入标准的试验。 CN和RE提取的数据。使用了Cochrane协作的评估偏倚风险的工具。 CN与试验作者联系以澄清详细信息。主要结果：包括来自五项研究的十三份报告，总共450例患者。早期（四个月内）（5/149比0/100;优势比（OR）3.83，95％置信区间（CI）0.45至32.64）和晚期再通气后，EVLT后再通率比HL / S更高。 （四个月后）（9/118对1/80; OR 2.97; 95％CI 0.52至16.98），尽管这些结果在统计上并不显着。技术故障率优于HL / S（1/149对6/100; OR 0.12，95％CI 0.02至0.75）。与手术相比，RFA后的复发无差异。与HL / S相比，RFA后四个月内再次通气的频率更高，尽管无统计学意义（4/105对0/88; OR 7.86，95％CI 0.41至151.28）。四个月后，未观察到差异。与RFA相比，HL / S术后更频繁地观察到新血管形成，但这又没有统计学意义（3/42对8/51; OR 0.39，95％CI 0.09至1.63）。与HL / S相比，RFA后技术失败的发生率较低，尽管这在统计学上并不显着（2/106对7/96; OR 0.48，95％CI 0.01至34.25）。没有比较HL / S与USGFS的随机临床试验符合我们的研究纳入标准。 QoL评分和手术并发症不适合荟萃分析。作者的结论：目前可获得的临床试验证据表明，RFA和EVLT在治疗大隐静脉曲张方面至少与手术一样有效。没有足够的数据来评论USGFS。需要进一步的随机试验。我们应该以一致的方式报告和分析结果，以利于将来的荟萃分析。

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