Meta-analysis Of Curative Effect Comparison Between CHIVA And High Ligation And Stripping In The Treatment Of Varicose Veins Of Lower Extremities

Objective: To compare the clinical efficacy of conservative hem odynamics of ambulatory venous insufficiency(CHIVA)and high liga tion and stripping(HLS)in varicose veins through the meta-analysi s.Methods: A comprehensive and systematic search was conducted on Pub Med,Embase,Cochrane Database,web of science,VIP,Wanfang and CNKI of systematic reviews for relevant English-language and Chinese-language studies from inception to now.A database was established based on all the relevant literature according to the requirements of meta-analysis,including randomized controlled trials(RCTs)and controlled clinical trial(CCTs).And Rev Man 5.3 software was applied for meta-analysis to evaluate the operative time,inpatient days,intraoperative blood loss,postoperative complications,the cure rate and the recurrence rate.Results: A total of 9 articles were collected,of which 3 were randomized controlled trials and 6 were retrospective cohort.All the studies contain 12472 patients,CEAP grades were distributed amon g C2-C6.The results of Meta-analysis showed that in the treatment of varicose veins,compared with the stripping,cure rate(OR=2.14,95%CI:1.09-4.21,P=0.03),suggesting that the cure rate of stripping group was better than that of CHIVA group.Recurrence rate(OR=0.19,95%CI:0.05-0.67,P=0.01),suggesting that there was no signific ant difference in recurrence rate between the two groups.CHIVA al so could can reduce the incidence of postoperative complications,m anifested as nerve injury(OR=0.40,95%CI:0.19-0.84,P=0.02),bruisi ng(OR=0.76,95%CI:0.18-3.20,P<0.05),severe pain(OR=0.16,95%C I:0.09-0.28,P<0.05),hematoma formation(OR=0.46,95%CI:0.24-0.88, P<0.05),paresthesia(OR=0.08,95%CI:0.02-0.28,P<0.05).But there was also no significant difference in some of postoperative compli cations,such as superficial thrombophlebitis(OR=0.88,95%CI:0.49-1.56,P=0.65),deep venous thrombosis(OR=0.22,95%CI:0.04-1.30,P=0.09),wound infection(OR=0.80,95%CI:0.36-1.78,P=0.59).At last, CHIVA also can significantly shorten the hospitalization time(MD=-4.58,95%CI:-4.98--4.17,P<0.05)and reduce the amount of intraop erative blood loss(MD=-8.62,95%CI:-10.79--6.45,P<0.05),but there was no significant difference between operation time in the two gr oups(MD=-8.09,95%CI:-17.69-1.50,P=0.1).Conclusion: In terms of postoperative efficacy,the recurrence rat e of CHIVA was lower than that of high ligation and stripping,and th e cure rate of high ligation and stripping was better than that of CHI VA.Compared with high ligation and stripping,CHIVA can reduce th e incidence of postoperative complications such as paresthesia,nerve i njury,postoperative severe pain and hematoma formation.CHIVA can reduce intraoperative blood loss and hospital stay.