Comparative Analysis Of Clinical Efficacy Of Endovenous Laser Ablation Combined With High Ligation And Conventional Stripping Surgery In The Treatment Of Primary Great Saphenous Varicose Veins

Objective:To compare and analysis the difference of curative effect between endovenous laser ablation(EVLA)combined with high ligation and high ligation and stripping(HL/S)surgery in the treatment of primary great saphenous varicose veins(pGSVV).And to explore its advantages and disadvantages,related complications after EVLA combined with high ligation.Methods:The clinical data of 368 patients with unilateral pGSVV in the first affiliated Hospital of Nanchang University from January 2016 to December 2017 were collected.According to the different surgical methods,they were divided into group HL/S(great saphenous vein high ligation + stripping + sclerotherapy)and group EVLA(great saphenous vein high ligation + laser + sclerotherapy),with 152 cases and 216 cases respectively.CEAP classification was used to classify the severity of the disease,and the preoperative,intraoperative and postoperative data of the two groups were statistically analyzed and compared.Results:All 368 patients successfully completed the corresponding treatment.there was no statistically significant difference between HL/S group and EVLA group in general data including gender,age,affected limb,duration of disease,CEAP classification and CIVIQ scores(P>0.05).There were statistically significant differences between the HL/S group and the EVLA group in operation time(56.78±21.60 min VS 46.51±15.16min),the amount of intraoperative blood loss(64.36±16.86 mL VS 45.30 ± 10.85mL),postoperative hospital stay(5.61 ± 1.94 d VS 3.87 ± 1.29d),treatment cost(? 9449.95 ± 818.45 yuan VS 12071.06 ± 1148.81 yuan)(P<0.05).There were statistically significant differences between the two groups in postoperative complications such as incision infection,brusing,subcutaneous hematoma,sensory abnormality and pain requiring analgesic treatment(P<0.05),and the incidence of HL/S group was higher than that of EVLA group.There was no statistically significant difference between the two groups in four complications as postoperative edema,pigmentation,thrombophlebitis,deep vein thrombosis(P>0.05).The overall recurrence rate 2 years after surgury was 10.53% in the HL/S group and 8.80% in the EVLA group.There was no statistically significant difference in the follow-up data of clinical recurrence,reflux / recanalization and reintervention(P>0.05).Except for the average CIVIQ score at 3 months after the HL/S group,the rest postoperation average scores of the two groups were no less than 80 points,which was in the range of satisfactory health quality of life;The average scores of 3 months after EVLA combined with high ligation was higher than that of the HL/S group,the difference was statistically significant(78.75 ± 8.97 points VS 80.87 ± 7.76 points,P<0.05).The difference in average CIVIQ scores at 6 months,1 year,and 2 years after operation between the two groups was not statistically significant(P>0.05).Conclusions:EVLA combined with high ligation was safe,simple and effective in the treatment of pGSVV.Compared with HL/S,there is no significant difference in postoperative clinical recurrence,reflux and improvement of health quality of life,but EVLA combined with high ligation has more advantages in shortening operation time,reducing intraoperative blood loss and postoperative pain,and reducing the incidence of complications,it is worthy of clinical application.