用同轴导管系统作精索静脉曲张的经皮硬化疗法

目前经皮注射硬化剂治疗精索静脉曲张的意义是无异议的,很多研究工作都分析了其远期效果并特别探讨复发的原因。很多病例的复发都与精索静脉的再通及该静脉主干近端阻塞后形成的侧支循环有关。新的研究指出,外周硬化剂治疗后其复发率明显降低(从32%降到18%)。本文介绍的导管系统就是简便的方法,高效地进行外周硬化治疗(图1)。     

DSA引导下经导管聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡的临床疗效观察

目的 探讨DSA引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡的技术方法、可行性、安全性和临床疗效.方法 选择36例(48条患肢)下肢静脉曲张伴溃疡的患者,患肢溃疡面平均为(3±1.5)cm2(1 ～7 cm2),均为内踝处溃疡.术中于腹股沟小切口高位结扎大隐静脉主干后,经大隐静脉远侧断端或经皮穿刺患肢内踝处大隐静脉,置入4F造影导管,DSA引导下经导管注入聚桂醇泡沫硬化剂,选择性硬化闭塞大隐静脉及交通静脉,术后患肢加压包扎、应用抗生素、局部换药.结果 在DSA引导下48条患肢均成功注入泡沫硬化剂,每条患肢平均注入6.5 ml(3.5～8.5 ml)泡沫硬化剂,无严重并发症发生.术后当日患者能下床活动.两周后,38条患肢(79.1％)下肢溃疡创面愈合,8条患肢(16.7％)溃疡创面明显缩小,2条患肢(4.16％)创面未扩大.6 ～12个月后随访:45条患肢(93.8％)曲张静脉及溃疡消失,3条患肢(6.25％)溃疡复发.结论 DSA引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡临床疗效满意,是一种安全、有效的治疗下肢静脉曲张性溃疡的微创方法.     

透视引导下鱼肝油酸钠泡沫硬化剂治疗下肢静脉曲张30例

目的 探讨用国产鱼肝油酸钠自制泡沫硬化剂治疗下肢静脉曲张的临床效果.方法 选择河南开封市第一人民医院30例(39 条患肢)下肢静脉曲张患者,对其进行透视引导下曲张隐静脉注射自制鱼肝油酸钠泡沫硬化剂,观察大隐静脉的闭合情况.结果 39 条患肢均成功注射泡沫硬化剂,平均每条患肢使用5.9 ml泡沫硬化剂.35条(90%)大...     

无水酒精加钢丝圈作精索静脉曲张的栓塞疗法

1990年初以来,我们采用经皮无水酒精加钢丝圈作精索静脉曲张的栓塞疗法,获得满意效果。现报告如下。费科与方法 1990年1月～1991年12月,对门诊18例年龄在23～38岁,平均26岁的精索静脉曲张患者,进行精索静脉造影。15例为单侧性,均在左侧,3例为双侧性。其中10例有不育史。操作方法:局麻下,采用Seldinger氏法,经皮穿刺股静脉,将6.5～7.0F限镜蛇导管送入肾静脉内,并进行造影,观察肾静脉有无变异,观察精索静脉开口及有无逆流。然后将导管超选择插入精索静脉内,在直导丝引导下,将导管送进4～6cm,用60％泛影葡胺10ml,在Valsalva动作时手推逆行造影快速点片两张,观察精索静脉曲张的情况以及导管头端位     

X线透视引导下下肢静脉曲张泡沫硬化治疗的技术方法和疗效观察

目的 探讨在X线透视引导下使用泡沫硬化剂治疗下肢静脉曲张的技术方法、可行性、安全性和临床效果.方法 16例下肢静脉曲张患者的21条下肢.使用鱼肝油酸钠溶液按Tessari法制作泡沫硬化剂(液体气体比为1∶4)进行硬化治疗.所有患者直接在局部穿刺行曲张静脉造影,在X线透视引导下,见低密度的泡沫硬化剂完全置换曲张浅静脉内的对比剂和(或)泡沫即将进入相交通的浅、深静脉时立即停止注射.术后使用弹力绷带压迫24 h再改穿弹力袜2周.临床疗效评价标准分为治疗成功、部分成功和未成功.并发症分为轻微并发症和严重并发症.结果 所有患者均成功地完成了经皮穿刺泡沫硬化治疗.治疗后平均随访6.0个月(3.0～17.0个月),随访期内17条下肢(81.0%)获得治疗成功,4条下肢(19.0%)获得部分治疗成功.所有患者发生的早期轻微并发症均为自限性,包括术后早期沿曲张静脉走行的条索状硬结(21条)、色素沉着(11条)、局部疼痛(7条)和浅表性静脉炎(1条),未发生严重并发症和全身并发症.结论 X线透视引导下使用泡沫硬化剂治疗下肢静脉曲张是安全、有效的.     

DSA引导下泡沫硬化治疗下肢静脉曲张的临床疗效

目的 探讨DSA引导下泡沫硬化治疗下肢静脉曲张的临床疗效.方法 利用Tessari法制作鱼肝油酸钠泡沫硬化剂,在DSA引导下硬化治疗20例(25条患肢)下肢静脉曲张患者,临床随访6个月,参照CEAP分级及临床症状、体征变化判断其临床疗效.结果 在DSA引导下对25条患肢成功实施曲张静脉的泡沫硬化治疗,技术成功率为100...     

DSA引导下经皮硬化术治疗儿童唇部低流速静脉畸形的疗效和安全性分析

目的探讨DSA引导下3%聚多卡醇泡沫硬化剂、平阳霉素联合地塞米松治疗儿童唇部低流速型静脉畸形的疗效和安全性。方法分析我院全麻下行DSA引导下经皮硬化术治疗的27例儿童唇部低回流型静脉畸形患儿的临床资料。共纳入27例患者35个病灶,将观察对象随机分为两组,A组:13例患儿16个病灶,接受3%聚多卡醇泡沫硬化剂治疗;B组:14例患儿19个病灶,接受平阳霉素+地塞米松混合剂注射治疗。观察两组的临床疗效,记录术后不良反应情况,并将其进行对比分析。结果 A组与B组间平均治疗次数、有效率差异无统计学意义(P0.05);两组的不良反应发生率差异有统计学意义(P0.05)。结论 DSA引导下3%聚多卡醇泡沫硬化剂、平阳霉素联合地塞米松治疗儿童唇部低流速型静脉畸形均是有效的方法。平阳霉素联合地塞米松较聚多卡醇泡沫硬化剂更为安全、不良反应少,更值得临床推广。     

自制同轴导管在精索内静脉栓塞中的应用

精索静脉曲张是蔓状静脉丛的扩张,为男性生育能力低下的常见原因.精索静脉的导管栓塞,作为精索静脉曲张的一种新的治疗方法,具有损伤小、疗效可靠、能在门诊施行等优点。我们在15例导管栓塞的基础上,对原有的导管和插管方法进行了改进.利用硬脊膜麻醉导管与 F_7导管配套制成简易同轴导管,施行超选择性插管,栓塞4例患者,均获得满意结果.该法且可随意选择栓塞平面.     

透视下聚多卡醇硬化治疗C 5~C 6期下肢静脉性溃疡的疗效

目的：探究透视引导下经浅表静脉注入聚多卡醇泡沫硬化剂治疗C₅~C₆期下肢静脉性溃疡的疗效。 方法：选取2014年9月—2015年8月在广州市番禺中心医院诊治的下肢静脉曲张达C₅~C₆期患者51例,共64条患肢,按国际静脉联盟分级（CEAP）标准进行评级,C₆期患肢28条;C₅期患肢36条。应用不同浓度聚多卡醇进行硬化治疗。于术后2周、3个月、6个月对患者进行门诊随访,评价患者疗效、症状改善及不良反应发生情况。 结果：64条患肢均注射成功,平均每条患肢泡沫硬化剂用量（16.35±1.36）ml。术后2周、3个月和6个月随访中,C₆期（28条）患肢溃疡逐渐愈合,C₅期（36条）患肢溃疡周围皮肤张力下降,所有患者症状有不同程度改善,色素沉着明显减轻。 结论：透视引导下聚多卡醇泡沫硬化剂治疗C₅~C₆期下肢静脉曲张安全,疗效可靠,无严重并发症。     

NT—海球栓栓塞治疗精索静脉曲张的临床应用

ＮＴ—海球栓栓塞治疗精索静脉曲张的临床应用江苏徐州解放军第９７医院放射科马广勤，万向荣江苏徐州解放军第９７医院泌尿科许承斌精索静脉（ＳＶ）曲张是青少年乃至成人男性的常见病，传统需手术治疗。随着介入放射学的迅速发展，经皮导管法栓塞曲张的ＳＶ已逐步应用于...     

Percutaneous sclerotherapy of testicular vein insufficiency in persistent and recurrent varicocele

Among 1217 retrograde phlebographies of left-sided idiopathic varicoceles 66 patients presented because of persistence or recurrence of varicocele, 34 of them after operation and 32 after sclerotherapy. After operation without success there was always - except for one case - a reflux passing the site of ligature. If persistence or recurrence of varicocele occurred after sclerotherapy, the testicular (internal spermatic) vein was most often found to be obliterated at the junction with the renal vein and the sonographically proven reflux went via collaterals or unidentified veins which prevented a repeat sclerotherapy. In 12 out of 32 patients after sclerotherapy a persistent main stem of the testicular vein allowed a second attempt of sclerotherapy. If sclerotherapy in patients after operation or previous sclerotherapy could be performed, it was an effective, low risk procedure on an outpatient basis just as in primary sclerotherapy of testicular vein insufficiency causing varicocele.     

Percutaneous treatment of varicocele

Percutaneous occlusion of the spermatic vein has been performed in 104 patients with varicocele in the last five years. We report our long-term results on the first 87 cases with a follow-up of at least six months. The occlusion of the gonadal vein is generally induced by selective transcatheter injection of sclerosing agent. Our patients are always evaluated before and after sclerotherapy by telethermography and/or doppler examination. Furthermore spermiogram is obtained before and six months after therapy. We registered only four recurrences with no major complications.     

Varicocele: the effects of sclerotherapy on hemodynamics and spermatogenesis

Between January 1984 and July 1988, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 267 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. Nine of the patients had relapses after surgery. Long-term follow up was available for 248 patients. Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe and effective procedure to be preferred to surgery in the management of varicocele.     

Interventional Radiology of Male Varicocele: Current Status

Varicocele is a fairly common condition in male individuals. Although a minor disease, it may cause infertility and testicular pain. Consequently, it has high health and social impact. Here we review the current status of interventional radiology of male varicocele. We describe the radiological anatomy of gonadal veins and the clinical aspects of male varicocele, particularly the physical examination, which includes a new clinical and ultrasound Doppler maneuver. The surgical and radiological treatment options are also described with the focus on retrograde and antegrade sclerotherapy, together with our long experience with these procedures. Last, we compare the outcomes, recurrence and persistence rates, complications, procedure time and cost-effectiveness of each method. It clearly emerges from this analysis that there is a need for randomized multicentre trials designed to compare the various surgical and percutaneous techniques, all of which are aimed at occlusion of the anterior pampiniform plexus.     

Long-term results after sclerotherapy of the spermatic vein in patients with varicocele

Ninety-seven patients received transfemoral sclerotherapy of the spermatic vein for varicocele. After observation for 2 to 5 years, follow-up was available in 69 patients (71.2%), in 11 of whom the procedure failed (16.0%). Complications during angiography (N=12, 12.4%) or sclerotherapy (N=31, 32.0%) did not require hospital treatment. At least one parameter of the spermiogram was improved in 25 of 32 patients (78.1%). Forty-four of 69 patients (63.8%) treated because of a childless marriage, and whose wives were not known to be intertile, had a pregnancy rate of 47.7%. Thi method may be considered equal to surgical procedures in achieving venous occlusion; furthermore it is simple and can be used on an outpatient basis without anesthesia.     

超声引导下聚多卡醇泡沫硬化治疗肾囊肿的临床应用价值

目的探讨超声引导下聚多卡醇泡沫在肾囊肿硬化治疗中的临床应用价值。 方法分析我院于2019年1月至2020年6月期间收治的42例肾囊肿患者，均在超声引导下行聚多卡醇泡沫硬化治疗，所有患者在术后1、3、6、12个月定期随访复查超声，根据囊肿的缩小率评价疗效。 结果42例患者的42个肾囊肿，术后1、3、6、12个月随访，治愈率分别为11.9%、35.7%、42.9%、59.5%；总有效率分别为59.5%、83.3%、92.9%、100.0%。Cox多因素回归分析显示囊肿容积的大小为影响聚多卡醇治疗效果的主要因素。 结论超声引导下聚多卡醇泡沫硬化治疗肾囊肿安全、有效，术后随访时间越长，治疗效果越显著，且囊肿容积越小，疗效越确切，值得在临床推广应用。     

Percutaneous treatment of varicocele. 13-year experience with the transbrachial approach

PURPOSE: To report our experience using the transbrachial approach, which is easily accepted by the patient, in the treatment of varicocele. MATERIAL AND METHODS: Between January 1986 and December 1998, 1490 patients with clinical or subclinical varicocele, but with seminal fluid alterations, underwent spermatic phlebography using the transbrachial approach. Since 1991 the procedure has also been adopted at the Unit of Pediatric Surgery of our hospital, which proposes it as a first choice treatment in adolescents with varicocele. The procedure consists in accessing the basilic vein at the elbow level percutaneously and using a hydrophile guidewire and multipurpose angiographic catheter to reach and catheterise the spermatic vein responsible for the varicocele. During the first years, we used sclerotherapy alone; subsequently, if the varicocele recurred or if the reflux was refractory to sclerotherapy or if the veins were large we adopted vein embolisation. Follow-up was one year and consisted of testicular ultrasound, Doppler flowmetry and/or color Doppler ultrasound at one, six and twelve months after the procedure. Patients were considered restored if they were free of symptoms, showed no venous reflux and/or had normal seminal fluid parameters and improved if they were free of symptoms but still presented venous reflux. Varicocele was considered persistent if the procedure failed to produce any beneficial effects, and recurrent if, although absent at the first follow up, it reappeared after the fifth month. RESULTS: We found 1296 (86.9%) cases of left varicocele, 25 of right varicocele and 169 (11.3%) of bilateral varicocele. In all cases, the symptoms disappeared after the percutaneous procedure. Duration of radioscopy was reduced to 3.5'; the procedure lasted 90' for the monolateral varicoceles and 120' for the bilateral forms. 313 diagnostic procedures were performed (20.7%). The procedure could not be completed in 104 patients (6.8%) due to basilic vein spasms, difficulties encountered in catheterizing the spermatic vein and, particularly in pediatric patients, anatomic variations. A total of 1195 (79.2%) procedures were completed: sclerotherapy alone in 642 patients and sclerotherapy followed by scleroembolisation in 527. Sclerotherapy alone was sufficient to restore 524 patients (86.6%), while 384 (78.5%) required scleroembolization. A small number of patients underwent scleroembolization alone, which brings the success rate for the two procedures to 82% and 84%, respectively. No serious side-effects were noted. DISCUSSION: The transbrachial approach in spermatic phlebography has proved to be a safe and effective technique for the treatment of both monolateral and bilateral varicocele. Furthermore, the procedure is well accepted by patients and can be performed in a day-care setting. In some cases, we only obtained partial results because of the large caliber of the spermatic vein; in other cases, we were unable to complete the procedure due to anatomic variations or to the spasm of the basilic vein. CONCLUSION: The safety and effectiveness of this procedure make it a valid alternative to traditional surgery, that should be considered as a possible first-choice treatment for varicocele in adolescents.     

Transcatheter Foam Sclerotherapy of Symptomatic Female Varicocele with Sodium-Tetradecyl-Sulfate Foam

To evaluate the efficacy of transcatheter foam sclerotherapy (TCFS) in pelvic varicocele using sodium-tetradecyl-sulfate foam (STSF), we conducted a retrospective study in 38 patients (mean age, 36.9 years; range, 22–44 years) with pelvic congestion syndrome (PCS) treated between January 2000 and June 2005 by TCFS. Pelvic pain was associated with dyspareunia in 23 (60.5%) patients, urinary urgency in 9 (23.7%) patients, and worsening of pain during menstruation and at the end of a day of work in 7 (18.4%) and 38 (100%) patients, respectively. Diagnosis was made by pelvic and transvaginal color Doppler ultrasound examination, demonstrating ovarian or pelvic varices with a diameter >5 mm presenting venous reflux. TCFS was performed in all patients, using 3% STSF. Follow-up was performed by physical examination, pelvic and transvaginal Doppler ultrasound examination and by a questionnaire-based assessment of pain at 1, 3, 6, and 12 months after the procedure. Technical success was achieved in all patients (100%). In three patients a pelvic colic-like pain occurred immediately after sclerotic agent injection, disappearing spontaneously after a few minutes. No recurrent varicoceles were observed during a 12-month follow-up. A statistically significant improvement in each category of specific symptoms was observed at 1, 3, 6, and 12 months after the procedure. We conclude that TCFS of female varicocele using a 3% STSF is safe and effective for the treatment of PCS. It is associated with a significant reduction of symptoms and can be regarded as a valid alternative to other endovascular and surgical techniques.     

Solitary or predominantly right-sided varicocele: a possible sign of situs inversus

Among more than 850 patients undergoing outpatient sclerotherapy of the internal spermatic vein, only 1 unilateral and 1 predominantly right-sided varicocele were encountered. In both patients with this finding a total situs inversus was present, with inversion of normal anatomy, enlarged "right" internal spermatic vein draining into the renal vein, and the "left" internal spermatic vein entering the inferior vena cava directly. Total situs inversus should be considered whenever right-sided varicocele is solitary or predominant.