Advances in surgical procedures for varicose veins and treatment outcomes at our hospital

当院における下肢静脈瘤手術術式の変遷と治療成績

Advances in surgical procedures for varicose veins and treatment outcomes at our hospital

Creators Saito Satoshi

Creators Fujita Akihiro

Creators Otsuka Ryo

Creators Jinbo Mitsutaka

Creators Uesugi Naomasa

Creators Kobayashi Toshiro

Creators Takahashi Tsuyoshi

Creators Gohra Hidenori

【目的】下肢静脈瘤手術は長年ストリッピング手術が標準術式であったが,低濃度大量局所浸潤麻酔(TLA:tumescent local anesthesia)の活用や種々の工夫により低侵襲化と日帰り手術や早期退院が可能となった.更に近年は血管内焼灼術(ETA:endovenous thermal ablation)が登場し,各種波長のレーザー焼灼術(EVLA:endovenous laser ablation)や高周波焼灼術(RFA:radiofrequency ablation)が保険適用となっている.当院では2012年8月にETAを導入し現在まで複数の機器を使用してきたが,これら治療法の妥当性について検討を行った.【対象と方法】2012年8月から2020年7月までに当院で施行した伏在静脈系の下肢静脈瘤手術1,272例のうち,ストリッピング手術(ST群,311例),波長980nmのレーザーによるEVLA(980nm群,191例),波長1470nmのレーザーによるEVLA(1470nm群,717例),RFA(RF群,53例)を対象とし,各群の手術成績を比較した.【結果】手術時間はST群が他群より有意に長く,鎮痛剤の内服総数と術後皮下出血の頻度はST群と980nm群が多かった.EHIT(endovenous heat-induced thrombus)の発生率は各群間に有意差はなく,臨床上問題とされるclass3を1470nm群に4例認めたが経口抗凝固薬により改善した.いずれの群でも観察期間中の深部静脈血栓症と肺血栓塞栓症の合併を認めず,静脈の再疎通は980nm群に1例のみ認めた.【結語】当院のストリッピング手術とETAの治療成績は良好で重篤な合併症もなかった.特に波長1470nmのレーザーによるEVLAとRFAは手術時間の短縮と術後疼痛の軽減が得られ,再疎通はなく有用な治療法と考えられた.

Tumescent local anesthesia can alleviate the burden of varicose vein surgery, while endovenous thermal ablation is a new treatment, and endovenous laser ablation(EVLA)and radiofrequency ablation(RFA)are becoming common due to their recent inclusion in insurance coverage. In this study, surgical outcomes were compared among patients who underwent varicose vein stripping(ST group, 311 patients),EVLA using a laser with wavelengths of 980 nm(980 nm group, 191 patients)and 1470 nm(1470 nm group, 717 patients),and RFA(RF group, 53 patients).The operation time was significantly longer in the ST group than in the other groups, and pain and bruising were higher in the ST and 980 nm groups. There were no significant differences in the incidences of endovenous heat-induced thrombosis in all groups. Class 3 events were observed in 4 patients in the 1470 nm group, but were improved by oral anticoagulants. Complications of thromboembolism did not occur in any group, and venous recanalization was required in only one patient in the 980 nm group. These results show that 1470 nm EVLA and RFA shortened the operation time and reduced postoperative pain without causing serious complications, which suggests that these procedures are useful for treatment of varicose veins.

[ISSN]0513-1731

[NCID]AN00243156