超声引导下聚多卡醇泡沫硬化剂治疗大隐静脉曲张的早期临床疗效分析

目的:探讨聚多卡醇泡沫硬化剂治疗大隐静脉曲张的临床效果及大隐静脉主干硬化治疗的有效方法。方法:对35例大隐静脉曲张患者在超声引导下行泡沫硬化剂注射治疗,大隐静脉主干内注射3%聚多卡醇泡沫硬化剂,曲张静脉属支内注射1%聚多卡醇泡沫硬化剂。观察术后临床疗效及并发症发生情况。结果:35例患者均成功行超声引导下行泡沫硬化剂注射治疗,随访6个月以上,大隐静脉主干治疗段硬化闭塞良好,未见血流信号;术后6个月静脉临床症状严重程度评分VCSS评分较术前明显下降[(1.0+0.4)分vs.(4.2+1.5)分](P0.01);其中2例患者出现术中不良反应,3例患者需要行二次曲张静脉属支泡沫硬化剂注射治疗,所有患者均未发生深静脉血栓及肺栓塞等严重并发症。结论:超声引导下聚多卡醇泡沫硬化剂治疗大隐静脉曲张,具有创伤小、无严重并发症,可重复进行,近期随访效果良好等优点。     

聚桂醇泡沫硬化治疗下肢静脉曲张562例分析

目的探讨无超声引导下聚桂醇泡沫硬化治疗下肢静脉曲张的临床效果。方法 2009年10月～2011年4月对562例下肢曲张静脉穿刺进行聚桂醇泡沫硬化注射治疗,硬化剂泡沫使用20 ml注射器抽取10 ml空气注入含10 ml聚桂醇的安瓿瓶反复抽吸形成,再将10 ml含泡沫硬化剂的注射器与6号头皮针相连,硬化治疗下肢静脉曲张562例共613条患肢。结果 1周后复查曲张静脉触诊均变成硬条索状,未有触及软的曲张静脉,3个月后患者未诉有明显曲张静为治愈,1个疗程聚桂醇泡沫硬化治疗后治愈率98.2%（602/613）,2个疗程治疗后治愈率100%。并发症发生率12.3%（69/562）,其中干咳为主要并发症,占10.1%（57/562）。结论无超声引导聚桂醇泡沫硬化治疗下肢静脉曲张操作简单、有效、微创、安全。     

超声引导下泡沫硬化剂治疗下肢表浅静脉畸形25例疗效观察

目的 探讨超声引导下泡沫硬化剂对下肢表浅静脉畸形的治疗作用。方法 2009-2011年福建医科大学附属第一医院对25例下肢表浅静脉表浅畸形病人在超声引导下注射聚桂醇,观察注射后局部病灶内声像变化并随访观效。结果 25例病人中22例一次性硬化成功,未出现复发,3例病灶较大者经多次聚桂醇注射治疗后未出现再发。结论 泡沫硬化剂注射治疗下肢表浅静脉畸形效果满意,而超声能更精确地引导手术的进行。     

彩超引导下聚桂醇泡沫硬化治疗静脉畸形临床疗效观察

目的:分析彩超引导下聚桂醇泡沫硬化剂治疗静脉畸形的临床疗效。方法:选择笔者医院2012年11月~2013年6月收治的静脉畸形患者96例,其中婴幼儿35例,成人及儿童61例,分别行彩超引导下畸形管腔内注射聚桂醇泡沫硬化剂,观察治疗后畸形管腔闭合情况及吸收情况。96例患者均在彩超引导下分次、多部位成功注射聚桂醇泡沫硬化剂,每日1次,每次2~6ml,总疗程4~8次,疗程结束3个月后复查。结果:97.9%的患者经此方法治疗后,畸形血管腔全部或者部分闭塞吸收,肿块萎缩,颜色消退。治疗后2例患者出现轻微静脉炎症,经抗炎治疗后好转。2例患者因畸形静脉表浅,出现局部表皮小面积坏死,经对症处理后愈合。结论:聚桂醇泡沫硬化剂治疗静脉畸形临床疗效满意,合理应用该药物可显著提高静脉畸形的治疗效果。     

B超引导下多点注射聚桂醇治疗头颈部淋巴管畸形

目的:探讨B超引导下聚桂醇泡沫硬化剂腔内多点注射栓塞治疗头颈部淋巴管畸形的临床效果。方法:选取2016年9月-2018年8月笔者科室收治的淋巴管畸形患者11例,其中大囊型4例,微囊型2例,混合型5例,采用术中超声引导多点穿刺,边抽吸边注射,实时动态监测B超下聚桂醇泡沫硬化剂弥散范围,术毕加压包扎。结果:11例患者经1～3次治疗,术后随访3个月～1年,其中显效7例(巨囊型3例,混合型4例),有效3例(巨囊型1例,混合型1例,微囊型1例),无效1例(微囊型1例),总有效例数为10例。术后均未发生严重并发症。结论:B超引导下聚桂醇泡沫硬化剂腔内多点注射栓塞治疗头颈部淋巴管畸形定位精准,疗效肯定,安全性高,微创且无严重并发症,值得临床推广应用。     

超声介入穿刺注射聚桂醇治疗肝囊肿疗效分析

目的 探讨在超声引导下注射聚桂醇硬化剂治疗肝囊肿的临床应用价值及远期疗效.方法 110例术前经B超和CT检查确诊为单纯性囊肿的患者,在超声导向下应用一次性PTC针抽净囊液,并注射聚桂醇硬化剂治疗.术后分别于3个月及6个月、12个月、24个月后复查B超并进行对比.结果 术后3个月囊肿体积较术前有所缩小,术后6个月后囊肿体积较术前明显缩小甚至消失,术后24个月与术后6个月囊肿体积无明显差异.结论 超声引导下经皮肝囊肿聚桂醇硬化治疗有较高临床应用价值.     

聚桂醇泡沫硬化剂治疗体表静脉畸形的疗效

目的 探讨注射聚桂醇泡沫硬化剂治疗体表静脉畸形的疗效和安全性.方法 用1％聚桂醇注射液,按Tessari法制作泡沫硬化剂(液∶气为1∶4).在瘤体内注射泡沫硬化剂治疗体表静脉畸形患者21例.根据瘤体大小、患者年龄决定用药量,每次聚桂醇液体硬化剂用量在1～2 ml,每次聚桂醇泡沫硬化剂用量在8 ml以内,每隔4周重复注射1次,3～5次为1个疗程.根据治疗前后病灶大小、症状改善情况进行疗效评价,将治疗效果分为优、良、中、差4个等级;并通过治疗疗程及期间出现的并发症情况进行安全性评估.结果 21例患者,经3～18个月随访,优10例(47.6％),良9例(42.9％),中2例(9.5％).所有患者每次治疗后均可发生注射部位肿胀,发热5例,21例均未发生严重并发症.结论 聚桂醇泡沫硬化疗法治疗体表静脉畸形安全、有效.     

泡沫硬化剂注射治疗下肢静脉曲张患者的护理

对52例下肢静脉曲张患者采用聚桂醇泡沫硬化剂注射治疗,结果所有病例成功注射聚桂醇泡沫硬化剂,未出现深静脉血栓形成、肺栓塞等严重并发症。注射后2～3d出院。1个月后复查治疗效果显著47例,行二次治疗4例,1例复发。提出注射前做好物品准备、皮肤护理及心理护理等,注射时严格遵守无菌操作原则、注射剂量准确,注射后做好肢体、注射部位护理,并发症的预防及处理,是保证治疗顺利进行及治疗效果的措施之一。     

聚桂醇局部注射对不同年龄和部位小儿血管瘤的疗效分析

目的探讨聚桂醇注射治疗小儿血管瘤的疗效。方法回顾性分析2014年6月~2019年6月间,在江门市妇幼保健院小儿外科收治的体表血管瘤患儿90例,给予多点注射聚桂醇治疗,采用Achauer疗效评价方法进行评估,记录瘤体面积变化、取得疗效所需的时间及并发症。结果聚桂醇第一疗程总体有效率95.56%,第二疗程有效率可达100%,其中头面颈部的体表血管瘤起效最快,年龄越小效果越好。四肢的血管瘤并发症最高,达5.56%;肿胀和疼痛是最常见的并发症。结论聚桂醇局部注射治疗小儿血管瘤取得良好的临床效果,疗程短且并发症发生率低,可广泛应用于小儿体表血管瘤的治疗。     

Nursing care for patients receiving injection of sclerosing foam for varix of lower limb

对52例下肢静脉曲张患者采用聚桂醇泡沫硬化剂注射治疗,结果所有病例成功注射聚桂醇泡沫硬化剂,未出现深静脉血栓形成、肺栓塞等严重并发症.注射后2～3 d出院.1个月后复查治疗效果显著47例,行二次治疗4例,1例复发.提出注射前做好物品准备、皮肤护理及心理护理等,注射时严格遵守无菌操作原则、注射剂量准确,注射后做好肢体、注射部位护理,并发症的预防及处理,是保证治疗顺利进行及治疗效果的措施之一.     

聚桂醇瘤内注射硬化治疗肝血管瘤的临床疗效

目的探讨超声引导下经皮经肝穿刺聚桂醇瘤内注射硬化治疗肝血管瘤的安全性及有效性。方法将56例肝血管瘤患者,随机分为对照组29例(34个瘤灶),行平阳霉素瘤内注射硬化治疗;研究组27例(33个瘤灶),行聚桂醇瘤内注射硬化治疗。观察治疗前和治疗后3、6个月时患者临床症状、瘤体大小变化及不良反应。结果对56例患者均顺利实施硬化治疗,手术成功率100%。对照组与研究组患者治疗前及治疗后3、6个月血管瘤平均最大直径的差异无统计学意义(P均0.05);治疗3、6个月的有效率分别为58.82%、70.59%和54.54%、66.67%,差异均无统计学意义。两组患者治疗中及治疗后均未发生严重并发症。结论超声引导下经皮穿刺瘤内注射聚桂醇硬化治疗肝血管瘤安全有效。     

泡沫硬化剂注射治疗下肢慢性静脉功能不全

目的 探讨泡沫硬化剂注射治疗下肢慢性静脉功能不全(CVI)的临床疗效.方法 2011年3月至2012年1月,对我院行泡沫硬化剂注射治疗的95例CVI患者(131条患肢,CEAP分级为C2～5级)的临床资料进行回顾性分析.结果 131条患肢均成功治疗,平均每条肢体应用泡沫硬化剂15.5 ml.31条(23.7％)肢体于治疗后2周复诊时实施了第2次注射治疗,其中3条(2.3％)肢体于治疗后1个月复诊时实施了第3次注射治疗.无严重并发症发生.结论 泡沫硬化疗法对各种类型的下肢CVI都有效,且简单易行,应扩大其临床适应证.     

超声介入硬化治疗大块型、巨块型肝血管瘤的远期疗效

目的研究超声介入硬化治疗肝血管瘤大块型、巨块型的临床价值和远期疗效。方法在超声引导下经皮肝穿刺由里向外,多点、多面向瘤体内注入硬化剂,按瘤体体积公式计算注药量,设计分次注药量。结果穿刺治疗3750例,消失率、基本消失率分别为大结节型98.45%、1.55%;大块型30.25%、31.65%;巨块型5.1%、0,巨块型中瘤体直径缩小1/2~2/3者占94.9%。穿刺治疗总有效率100%。并发肝内出血0.133%。结论超声介入治疗肝血管瘤大结节型、大块型为最佳治疗期,疗效满意,瘤体消失率高。远期观察无复发,对肝、肾功能无损伤,可达康复之目的。     

Comparative Study of Duplex-Guided Foam Sclerotherapy and Duplex-Guided Liquid Sclerotherapy for the Treatment of Superficial Venous Insufficiency

PURPOSE: To compare the preliminary results of hemodynamic changes between duplex-guided foam sclerotherapy and duplex-guided liquid sclerotherapy. METHODS: Seventy Seven limbs in 77 patients with isolated greater saphenous vein incompetence were treated with duplex-guided sclerotherapy. Thirty Seven limbs were treated with duplex-guided foam sclerotherapy and the remaining 40 limbs were treated with duplex-guided liquid sclerotherapy. Pretreatment exam was performed using a color duplex scanner and air plethysmography. The sclerosing foam was produced by Tessari's method using 1% and 3% polidocanol. The varicose vein was injected with 2 mL of 1% polidocanol or 1% polidocanol foam, and then 1 mL of 3% polidocanol or 3% polidocanol foam was injected into the greater saphenous vein under duplex guidance. Venous obstruction and recanalization were screened by serial posttreatment duplex examination, and posttreatment air plethysmography analysis was performed 3, 6, 9, and 12 months after the sclerotherapy. RESULTS: Duplex scanning demonstrated complete occlusion in the greater saphenous vein for duplex-guided foam sclerotherapy in 25 limbs (67.6%), which was a significantly higher proportion than for the duplex-guided liquid sclerotherapy (7 limbs, 17.5%, p<0.0001). Recurrent varicose veins were found in 3 patient (8.1%) in the duplex-guided foam sclerotherapy group and 10 (25%) in the duplex-guided liquid sclerotherapy group at 1-year (p=0.048). In duplex-guided foam sclerotherapy, venous filling index values remained normal during the subsequent follow-up examinations, whereas in duplex-guided liquid sclerotherapy, venous filling index began to increase, and there was a significant difference at 6 months between duplex-guided foam sclerotherapy and the duplex-guided liquid sclerotherapy (p<0.0005). At 9 months, there was a significant difference in the residual venous fraction between the two groups, and the residual venous fraction value continued to improve in duplex-guided foam sclerotherapy (p=0.033). CONCLUSIONS: Duplex-guided foam sclerotherapy could have greater promise compared to duplex-guided liquid sclerotherapy in the treatment of superficial venous insufficiency.     

Three-Dimensional Volumetric Analysis of Venous Malformations for Assessing the Effectiveness of Percutaneous Sclerotherapy

BACKGROUNDPercutaneous sclerotherapy can be used to successfully treat venous malformations (VMs) of the head, neck, and limbs. However, the standard curative effect of sclerotherapy has rarely been analyzed, and there is currently no accurate statistical method to measure the volume of VMs after sclerotherapy. Here, we propose a novel three-dimensional (3D) reconstruction method to evaluate this effect.OBJECTIVETo test the feasibility of 3D software (MIMICS 19.0) to evaluate the treatment effect of sclerotherapy.METHODSThis retrospective study included patients with VMs on the head, neck, and limbs who were treated with ethanol sclerotherapy or foam sclerotherapy every 8 weeks. MIMICS 19.0 was used to calculate the performance of the lesion after treatment and measure the VM volumes before and after the treatment. The effect of the clinical treatment dose on the lesion was evaluated, and the treatment effect of each patient was recorded. The relationship between the number of treatments and the reduced volume of VMs was analyzed.RESULTSBased on the MIMICS-calculated regions of interest (ROI), we found that 1 mL of ethanol reduced the lesion by 473 mm³ and that one dosage of foam (1 mL of polidocanol and 4 mL air content) reduced the lesion by 2 138 mm³, demonstrating that the foam sclerosing agent exhibited greater efficacy in this study.CONCLUSIONSThe MIMICS 3D volume reconstruction method can effectively and safely evaluate the efficacy of sclerotherapy and provide a preoperative evaluation. This method is simple, accurate, and feasible.     

Embolization of drainage veins used in sclerotherapy of hemangiomas]

To improve the result of sclerotherapy for hemangiomas, the drainage veins of hemangiomas were embolized by injecting 95% alcohol into the hemangioma cavities. Alcohol injected into the cavity had to drain away through the vein of hemangioma and result in damage of the endothelial cells, and thrombosis on the venous wall, then the drainage vein is embolized. With the result of embolization of the drainage vein, the sclerosant solution injected into the hemangioma cavity cannot flow off any more. The sclerosant solution got much time to bring drug action into play, so the curative effect was raised. 30 patients including 24 cavernous hemangiomas and 6 mixed hemangiomas were treated with this method. 15 cases were cured, 11 cases were effective and 4 cases were ineffective. The effective rate was 86.7%.     

超声在泡沫硬化剂闭合交通静脉治疗下肢静脉性溃疡中的作用

目的 探讨彩色多普勒超声在泡沫硬化剂闭合交通静脉治疗下肢静脉性溃疡中的作用.方法 选择2014年12月-2016年8月在重庆医科大学附属第一医院血管外科接受超声引导下泡沫硬化剂闭合小腿病变交通静脉的静脉性溃疡患者(C6期),观察术后皮肤溃疡的愈合情况并通过彩色多普勒超声对静脉闭合情况进行随访.结果 114例患者共119条患肢(C6期)接受治疗,术前超声检查证实均存在小腿交通静脉病变(1～3支).平均闭合小腿交通静脉2.1条(1～3条).术后平均随访11.3个月(1～21个月),术后1个月溃疡愈合率为100％,病变交通支闭塞率为100％;随访期间,溃疡复发3例(3条患肢),病变交通静脉再通8支.未出现严重并发症.结论 彩色多普勒超声能提高泡沫硬化剂闭合小腿交通静脉治疗下肢静脉性溃疡的疗效和安全性,具有较高的临床实用价值.     

Prospective randomised comparative study of visual foam sclerotherapy alone or in combination with ultrasound-guided foam sclerotherapy for treatment of superficial venous insufficiency: preliminary report

ObjectiveThe aim of the study is to compare ultrasound-guided foam sclerotherapy (UGFS: injection of foam sclerosant under ultrasound guidance) of the great saphenous vein (GSV) combined with visual foam sclerotherapy (VFS: injection of foam sclerosant under visual control) for varicose tributary veins and VFS alone in the treatment of GSV reflux.Design and methodsA total of 133 limbs in 97 patients with GSV reflux were randomised to receive either VFS alone or VFS combined with UGFS. In both groups, 1% polidocanol foam was used. Assessments included duplex ultrasonography, evaluation of Venous Clinical Severity Scores (VCSS) and CEAP (clinical, etiologic, anatomic, and pathophysiologic) scores. Ultrasonographic inspection of the foam in the GSV was carried out during 5 min before compression was applied. The primary ‘end’ point of the study was obliteration of the GSV at 6 months.ResultsA total of 51 limbs in 48 patients were treated with UGFS + VFS and the remaining 52 limbs in 49 patients were treated with VFS alone. There were no significant inter-group differences in patient age, male: female ratio, height, weight, body mass index, CEAP clinical scores or VCSS. The GSV diameter was 6.0 ± 1.7 mm (median ± interquartile range) in the UGFS + VFS group and 5.7 ± 1.6 mm in the VFS group (p = 0.419). The mean injected volume of foam for varicose tributary veins was 4 ± 2 ml in the UGFS + VFS group and 6 ± 2 ml in the VFS group, a significantly higher amount of foam being used in the latter (p < 0.001). However, the mean total amount of foam was greater in limbs treated with UFGS + VFS than in those treated with VFS alone (p = 0.017). Ultrasonographic inspection revealed complete vasospasm of the GSV in 37 (72.5%) limbs in the UGFS + VFS group and 29 (55.8%) in the VFS group during sclerotherapy (p = 0.097). At 6-month follow-up, complete occlusion was found in 23 limbs (45.1%) treated with UGFS + VFS and in 22 limbs (42.3%) treated with VFS. The difference between the two groups was not significant (p = 0.775). Reflux was absent in 30 limbs (58.8%) treated with UGFS + VFS and in 37 (71.2%) treated with VFS (p = 0.190). There was no inter-group difference in post-treatment VCSS (p = 0.223).ConclusionsThese results show that UGFS + VFS and VFS are equally effective for the treatment of GSV reflux, despite the lower volume of foam used for VFS alone.     

泡沫硬化剂注射术与大隐静脉剥脱术的近期疗效对照研究

目的 评价泡沫硬化剂注射术联合高位结扎术治疗下肢大隐静脉曲张的近期临床效果.方法 55例(55条肢体)下肢大隐静脉曲张患者随机分为两组:传统大隐静脉剥脱术组(A组,23例);大隐静脉高位结扎联合泡沫硬化剂注射术组(B组,32例),比较两组手术前后CEAP分级及静脉临床严重程度评分(VCSS)的变化.结果 A、B两组手术...