【摘要】 目的 探讨经内踝穿刺大隐静脉插管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张的临床疗效及安全性。方法 56例(64条患肢)下肢静脉曲张患者,经患肢内踝上方大隐静脉穿刺插管,在数字减影血管造影(DSA)及对比剂监控下边退导管边注入聚桂醇泡沫剂,至整个大隐静脉及穿支静脉完全栓塞为止。治疗前后临床症状改善情况的差异用Wilcoxon秩和检验。结果 58条患肢成功经内踝穿刺插管栓塞(90.6%,58/64),6条患肢切开暴露内踝大隐静脉插管栓塞(9.4%,6/64),每条患肢聚桂醇用量6.2～8.0 mL,平均(7.6±0.2)mL。64条患肢于术后7 d～1个月超声显示大隐静脉未见血流信号,7～14 d曲张静脉均塌陷,8例小腿溃疡术后3～4周愈合,6例出现浅静脉炎,7例第2天出现小腿轻度肿胀,无1例肺栓塞、深静脉血栓等并发症发生。随访6～30个月(平均21.6个月),所有患者临床症状明显减轻或消失,按临床表现-病因-病变解剖-病理生理(CEAP)分级与治疗前比较,差异有统计学意义(P<0.01)。结论 经内踝穿刺大隐静脉插管注入聚桂醇泡沫剂治疗下肢静脉曲张安全、副反应小,远期疗效肯定。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of the treatment of varicose veins of lower limbs,by puncturing large saphenous vein and then injecting lauromacrogol foam sclerosing agent through internal malleolus.Methods 56 cases(64 implicated limbs) with varicose veins of lower limbs were enrolled in this study.Through puncturing the large saphenous vein and inserting catheter to internal malleolus of the limb.Under the observations of DSA with contrast agent,the lauromacrogol agent was slowly injected into the saphenous vein accompanied by the retrieval of catheter,until the varicose vein piercing vein completely embolism.The difference of the clinical symptoms before and after treatment was analyzed with Wilcoxon signed rank test.Results 58(90.6%,58/64) patients were treated with the embolization through medial malleolus puncture,and 6(9.4%,6/64) patients were treated with the embolization after the incision of the great saphenous vein at medial malleolus.The total amount of foaming agent for each limb was 6.2 to 8.0 mL,mcan volume(7.6±0.2) mL.Doppler ultrasonography showed no blood flow signal in the saphenous vein of 64 extremities from 7 days to 1 months after the surgery,and all varicose veins collapsed in 7-14 days.8 cases of call ulcer recovered 3-4 weeks after the treatment;6 patients underwent superficial phlebitis after the cmbolism;and 7 cases appeared mild swelling on the 2nd day after surgery.No pulmonary embolism,deep venous thrombosis and other complications happened.The follow-up ranged from 6-30 months(mean time,21.6 months).The clinical symptoms of all patients relieved or disappeared.Based on the CEAP grading,there was significant difference between the group of after treatment and the group of before treatment(P<0.01).Conclusion The intravenous injection of lauromacrogol foam through internal malleolus puncture is a safe treatment for varicose veins of lower limbs,which has minimal side effects and good long-term efficacy.更多还原