目的：观察腔内激光闭合联合聚多卡醇泡沫硬化剂及地奥司明术后巩固治疗下肢静脉曲张的疗效，并探讨其对瘤坏死因子-α(TNF-α)、白介素-6(IL-6)的影响。方法选取2014年3月至2015年3月广州医科大学第一附属医院整形外科收治的60例下肢静脉曲张患者，按照随机数字表法将其分为对照组和观察组，每组30例。对照组采用对大隐静脉行高位结扎术以及剥脱术，术后进行加压巩固治疗。观察组采用腔内激光闭合及泡沫硬化剂聚多卡醇注射，术后加压并予口服地奥司明辅助巩固治疗。观察两组患者的手术时间、手术出血量、术后住院时间及术后并发症；采用静脉疾病临床分类系统(CEAP)、静脉临床严重程度评分(VCSS)评价两组疗效；比较两组患者治疗前后的TNF-α、IL-6水平。结果两组患者术后1个月CEAP临床分级均较治疗前下降，差异有统计学意义(P<0.05)；术后随访6个月，对照组患者的CEAP临床分级较术后上升发生率为26.67%(8/30)，明显多于观察组6.67%（3/30)，差异有统计学意义(P<0.05)；观察组患者术后6个月VCSS评分为(1.89±0.65)，明显低于对照组的(3.12±0.83)，差异有显著统计学意义(P<0.01)；观察组患者术后6个月血清TNF-α、IL-6浓度差值较术前明显减少[TNF-α(16.86±3.91) pg/mL vs (7.34±4.99) pg/mL；IL-6(31.96±9.78) pg/mL vs (5.81±4.11) pg/mL]，差异均有显著统计学意义(P<0.01)。结论腔内激光闭合联合泡沫硬化剂聚多卡醇及地奥司明术后巩固治疗能够明显减少CEAP临床分级与VCSS评分，短期疗效与常规手术治疗相当。同时，其能够明显减少术后复发率，远期疗效显著，可能与抑制TNF-α、减少IL-6生成相关。%Objective To observe the efficacy of endovenous laser combined with foam sclerotherapy and post-operative application of diosmin in treatment of varicose veins of lower extremity, and to study its effect on tumor necro-sis factor-α(TNF-α) and interleukin-6 (IL-6) in the patients. Methods Sixty patients with varicose veins of lower ex-tremity in the First Affiliated Hospital to Guangzhou Medical University from March 2014 to March 2015 were selected, which were divided into control group and the observation group based on random number table, with 30 patients in each group. The control group was treated with high ligation and stripping of great saphenous vein, as well as compres-sion after operation for consolidation therapy. The observation group was treated with endovenous laser combined with injection of polidocanol foam sclerotherapy, as well as compression and oral diosmin after operation for consolidation therapy. The operation time, bleeding volume, postoperative hospital stay and postoperative complications between the two groups were observed. The efficacy of two groups were evaluated by clinical, etiologic, anatomic, pathophysiologi-cal (CEAP) classification and venous clinical severity score (VCSS). The levels of TNF-α and IL-6 before and after treatment were compared between the two groups. Results One month after operation, the CEAP classification were significantly decreased in both groups compared with before treatment (P<0.05). The patients were followed up for 6 months after operation, and the incidence of increase in CEAP classification in control group was significantly higher than that in observation group, (26.67%(8/30) vs 6.67%(3/30), P<0.05. Six months after treatment, the scores of VCSS in observation group was significantly lower than that in control group, (1.89±0.65) vs (3.12±0.83), P<0.05. The concen-tration difference of serum TNF-αand IL-6 at postoperative 6 months in observation group were significantly decreased compared with before operation, (16.86±3.91) vs (7.34±4.99), (31.96±9.78) vs (5.81±4.11), and the differences were sta-tistically significant (P<0.01). Conclusion Endovenous laser combined with polidocanol foam sclerotherapy, as well as postoperative application of diosmin for consolidation therapy, can significantly reduce CEAP classification and the scores of VCSS, which results in equivalent short-term curative effect to conventional surgical treatment. At the same time, it can significantly reduce the postoperative recurrence rate, with significant long-term effect, and it may be related to inhibition of TNF-αand reduced IL-6.
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