Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis
Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis
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静脉内激光消融与高位结扎剥脱术治疗静脉曲张的比较：荟萃分析
作者：
Ye Pan;Junjiang Zhao;Jia;M. Shao;Jian Zhang
目的：评价静脉腔内激光消融术（EVLA）与高位结扎剥脱术（HLS）治疗原发性下肢静脉曲张的有效性和安全性。方法：本研究纳入了比较EVLA和HLS治疗静脉曲张的前瞻性非随机研究和随机对照试验。采用Mantel-Haenszel方法对13项临床试验的数据进行荟萃分析，并计算风险比。共有13项研究（共2245条肢体）符合纳入条件。其中1128条肢体行腔内激光消融术，1117条肢体行高位结扎加剥脱术。主要结果指标是不同随访时间的技术成功率和复发率以及并发症发生率。结果如下：初始技术成功率无显著差异，在1年和2年随访时，EVLA手术失败比传统手术更常见。然而，1年和2年后，传统手术和EVLA之间的肿瘤检测和临床复发率相似。EVLA和HLS的术后静脉炎和瘀伤无统计学意义（17.9% vs 21.5%）。然而，EVLA的并发症少于HLS，包括出血和血肿（1.28% vs 4.83%）、伤口感染（0.33% vs 1.91%）和感觉异常（6.73% vs 11.27%）。结论：与HLS相比，EVLA治疗静脉曲张在两年范围内是安全有效的。需要更多的随机对照研究随访结果来阐明长期复发（5年）。
Objectives: To evaluate the efficiency and safety of endovenous laser ablation (EVLA) for primary lower extremity varicosities compared with high ligation and stripping (HLS). Method: Prospective non-randomized studies and randomized control trials on comparison of EVLA and HLS in treating varicose vein were included in this study. A meta-analysis on the data of suitable 13 clinical trials was performed using the Mantel–Haenszel method and the risk ratio was calculated. Thirteen studies including a total of 2245 limbs were eligible for inclusion. Among them, 1128 limbs were treated with endovenous laser ablation, whereas 1117 were treated with high ligation and stripping. Primary outcome measures were technical success rates and recurrence rates at different follow-up duration and complication rates. Results: No significant difference in initial technical success rates, Procedural failures were more common following EVLA compared with conventional surgery at one- and two-year follow-up. However, the duplex-detected and clinical recurrence rate was similar between conventional surgery and EVLA after one and two years. No statistical significance was found in postoperative phlebitis and bruise in EVLA and HLS (17.9% versus 21.5%). However, fewer complications were observed in EVLA compared with HLS, including bleeding and haematoma (1.28% versus 4.83%), wound infection (0.33% versus 1.91%) and paraesthesia (6.73% versus 11.27%). Conclusions: EVLA for varicose veins is safe and effective compared with HLS in a two-year range. More randomized controlled studies follow-up results are needed to clarify longterm recurrence (5 years).