目的:为了研究技术可行性,手术技术,旨在纠正深静脉反流的手术的安全性和有效性结果,慢性静脉功能不全(CVI)患者。
方法:我们在PubMed,Embase和WebofScience从数据库开始到2022年2月。我们包括系统评价,RCT和观察性研究描述了由于原发性和继发性功能不全导致的深度反流患者的手术治疗方法,地铁后综合征(PTS)。对所有疗效和安全性结果进行比例荟萃分析。
结果:我们纳入了57项定量综合研究:3项RCT,包括252例患者,54项病例系列,包括4,004例患者。研究包括38名患者,平均年龄51岁;其中52%是男性。40%的研究包括2291名原发性无能患者,29%的研究包括595名PTS患者,31%的研究包括1,118名患有这两种疾病的患者。至于主要的无能,所有手术的汇总估计显示89%(95%CI,82-94%)的溃疡愈合,10%(4-18%)溃疡复发,98%(93-100%)瓣膜通畅,84%(78-90%)的瓣膜能力,0.05%(1/1904例)肺栓塞,1%(0-3%)伤口感染,5%(1-9%)血肿,2%(0-6%)淋巴囊肿,2%(1-4%)血栓形成,85%(74-94%)疼痛改善,89%(65-100%)水肿改善,85%(73-93%)的脂膜硬化改善。PTS患者的预后较差:82%(71-91%)的溃疡愈合,18%(5-36%)溃疡复发,88%(78-96%)瓣膜通畅,78%(66-88%)瓣膜能力,没有肺栓塞,6%(0-22%)伤口感染,6%(3-10%)血肿,5%(1-12%)淋巴囊肿,7%(1-16%)血栓形成,79%(59-94%)疼痛改善,75%(61-88%)水肿改善,64%(9-100%)改善脂膜硬化。
结论:“每个荟萃分析中包含的研究数量有限,并且知道该元素如何影响统计功效,以及缺乏比较对照组,不可能得出明确的结论。然而,DVRSR可能会增加CVI患者临床改善的可能性。即使在患者的一生中可能需要辅助手术,结果似乎也令人满意。因此,需要严格的随访方案来维持结果.需要进一步的研究来评估DVRSR,特别是与最近引入的静脉内方法相比。
OBJECTIVE: The aim of this study was to investigate the technical feasibility, operative techniques, safety, and efficacy outcomes of procedures aimed at correcting deep venous reflux, in patients with chronic venous insufficiency.
METHODS: We performed systematic literature searches in PubMed, Embase, and Web of Science from databases\' inception to February 2022. We included systematic reviews, randomized controlled trials, and observational studies describing surgical procedures to treat patients with deep reflux due to primary and secondary incompetence, post-thrombotic syndrome (PTS). Proportion meta-analyses were performed for all the efficacy and safety outcomes.
RESULTS: We included 57 studies in the quantitative synthesis: three randomized controlled trials including 252 patients and 54 case series including 4004 patients. Studies included a median of 38 patients, with a mean age of 51 years; 52% of them were males. Forty percent of studies included 2291 patients with primary incompetence, 29% of studies included 595 patients with PTS, and 31% of studies included 1118 patients with both diseases. As for primary incompetence, pooled estimates for all procedures showed an 89% (95% confidence interval [CI], 82%-94%) of ulcer healing, 10% (95% CI, 4%-18%) ulcer recurrence, 98% (95% CI, 93%-100%) valve patency, 84% (95% CI, 78%-90%) valve competence, 0.05% (1/1904 patients) pulmonary embolism, 1% (95% CI, 0%-3%) wound infections, 5% (95% CI, 1%-9%) hematoma, 2% (95% CI, 0%-6%) lymphocele, 2% (95% CI, 1%-4%) thrombosis, 85% (95% CI, 74%-94%) pain improvement, 89% (95% CI, 65%-100%) edema improvement, and 85% (95% CI, 73%-93%) lipodermatosclerosis improvement. Patients with PTS showed less favorable outcomes: 82% (95% CI, 71%-91%) of ulcer healing, 18% (95% CI, 5%-36%) ulcer recurrence, 88% (95% CI, 78%-96%) valve patency, 78% (95% CI, 66%-88%) valve competence, no pulmonary embolism, 6% (95% CI, 0%-22%) wound infections, 6% (95% CI, 3%-10%) hematoma, 5% (95% CI, 1%-12%) lymphocele, 7% (95% CI, 1%-16%) thrombosis, 79% (95% CI, 59%-94%) pain improvement, 75% (95% CI, 61%-88%) edema improvement, and 64% (95% CI, 9%-100%) lipodermatosclerosis improvement.
CONCLUSIONS: The number of studies included in each meta-analysis are limited, and knowing how this element can affect the statistical power, as well as the absence of comparative control groups, it is not possible to draw definitive conclusions. Nevertheless, deep venous reconstructive surgery for reflux may increase the probability of clinical improvement in patients affected by chronic venous insufficiency. Outcomes appear to be satisfactory even if possible adjunctive procedures may be required over the course of the patient\'s lifetime. Consequently, a strict follow-up protocol is required to maintain outcomes. Further studies are required to evaluate deep venous reconstructive surgery for reflux particularly as to how it compares with the more recently introduced endovenous approaches.