Comparison of the effects between traditional open surgery and laser treatment combined with foam sclerotherapy on immune system in patients with primary great saphenous varicose veins

Objective To compare the effects of traditional open surgery and laser therapy combined with foam sclerotherapy on immune system in patients with primary saphenous varicose veins. Methods A total of 104 patients who underwent elective varicose vein surgery were divided into the laser therapy combined with foam sclerotherapy group （MIS group，n=53） and traditional open surgery group（OS group，n=51） according to the surgical method.Venous blood sample was collected before and 24 h after operation for the measurement of superoxide dismutase （SOD）， interleukin （IL）-1β， IL-6 and IL-8， IL-10， tumor necrosis factor-α （TNF-α） and interferon-γ （IFN-γ） levels. The changes in the proportion of T cell subsets and NK cells were detected by flow cytometry. The expression levels of differentially-expressed genes （DEGs） of immune cells in peripheral blood were determined by single-cell RNA sequence （scRNA-seq） technology. Results In the MIS group， no significant differences were observed in the levels of SOD， IL-6， IL-10， TNF-α and IFN-γ before and after operation （all P > 0.05） except that IL-1β and IL-8 levels were increased after operation （both P < 0.05）. In the OS group， significant differences were noted in the above indicators before and after operation （all P < 0.05）. No significant differences were found in the proportion of T lymphocyte subsets and NK cells before and after surgery in the MIS group （both P > 0.05）， while the proportion of CD8+T cells was increased at postoperative 24 h， and that of NK cells was significantly reduced in the OS group （both P < 0.05）. Functional enrichment analysis of the DEGs in peripheral blood immune cells at postoperative 24 h indicated that postoperative hypoxia response， IFN response， and NF-κB inflammatory signaling pathways in the OS group were significantly up-regulated compared with those in the MIS group. Conclusion Laser treatment combined with foam sclerotherapy exerts slight effect on the immune inflammation and hypoxic response of the body system in patients with primary saphenous varicose veins. MIS can better maintain the body’s immune balance and preserve the capability of original immune system to resist microbial invasion to a greater extent compared with traditional OS.