Outcomes of Fluoroscopy-Guided Percutaneous High Ligation of the Great Saphenous Vein Combined With Foam Sclerotherapy for Symptomatic Great Saphenous Veins

PurposeTo evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the great saphenous veins (GSVs).Materials and MethodsThis was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSVs (133 limbs) that were treated with FPHL combined with FGFS between April 1 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was ligated percutaneously by a percutaneously-positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods.ResultsThe technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%) and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events.ConclusionsFPHL combined with FGFS to treat varicose veins in the GSVs achieved an occlusion rate of 92% and improved the clinical symptoms within 1 year; this minimally-invasive procedure was safe and effective.     

腔内射频消融联合泡沫硬化剂治疗下肢静脉曲张的临床效果评价

目的探讨腔内射频消融联合泡沫硬化剂治疗下肢原发性大隐静脉曲张的临床治疗效果。 方法采用回顾性病例对照研究分析2016年6月至2018年12月东南大学附属徐州医院(徐州市中心医院)血管外科收治的520例原发性大隐静脉曲张患者，其中男性300例，女性220例；年龄30～80岁，平均(60±2)岁。研究组共纳入260例经腔内射频消融联合泡沫硬化剂注射治疗的原发性大隐静脉曲张患者，共320条肢体，所有患者在彩色多普勒超声引导下对大隐静脉主干予以射频消融闭合。同时联合小腿段曲张静脉及交通支点状剥脱和泡沫硬化剂应用进行治疗。同期260例接受传统手术的大隐静脉曲张患者作为对照组。比较两组手术时间、术中出血量、术后早期下床活动时间、住院时间、术后疼痛评分以及隐神经损伤、切口感染、深静脉血栓形成、血肿等并发症的发生率，同时对两组患者进行随访，比较两组术后生活质量、术后6个月和12个月大隐静脉主干闭合情况以及1年下肢静脉曲张复发率。 结果研究组手术时间(30.0±3.6)min比对照组(60.4±5.9)min、出血量(20.3±4.6)mL比对照组出血量(80.0±3.2)mL、术后早期下床活动时间(1.0±0.3)h比对照组(6.3±2.0)h、住院时间(2.0±0.8)d比对照组(7.5±1.2)d、术后疼痛评分(3.2±0.3)分比对照组(5.4±1.2)分以及隐神经损伤率0(0/260)比对照组2.3%(6/260)、切口感染0(0/260)比对照组3.0%(8/260)、深静脉血栓形成率0(0/260)比对照组1.9%(5/260)、大腿段血肿发生率0(0/260)比对照组6.9%(18/260)均低于传统手术组，生活质量评分(56.78±3.21)也较对照组术后(42.23±2.81)明显改善，差异均有统计学意义(P均<0.05)。术后随访结果显示：6个月时，研究组有3例患者大隐静脉主干出现部分血流；12个月时为5例。但血液返流到大腿中段即消失，小腿段未见明显曲张血管。而对照组6个月和12个月时的大隐静脉再通率分别为1.5%(4/260)和1.9%(5/260)，但两组患者术后1年的下肢静脉曲张复发率的差异无统计学意义(P>0.05)。 结论腔内射频消融联合泡沫硬化剂注射对原发性大隐静脉曲张的疗效肯定，短期及中期效果好，为日间手术提供一种较好的模式。     

套扎及硬化术治疗食管下段胃底静脉曲张15例分析

目的探讨食管下段胃底静脉曲张内镜下治疗及其安全性.方法 1995年3月至2005年5月对15例食管下段胃底静脉曲张患者行硬化和套扎治疗. 结果 1例胃底静脉曲张出血急诊硬化治疗后血止,硬化术中出血4例,经再次注射或附加气囊压迫后血止,套扎术未并发术中出血,1例套扎术后第13天再次出血,内科治疗无效,改行手术治疗. 结论内镜治疗对食管下段胃底静脉曲张疗效较满意,初步印象中套扎治疗对静脉曲张明显者安全性较高.     

Percutaneous sclerotherapy of massive macrocystic lymphatic malformations of the face and neck using fibrin glue with OK-432 and bleomycin

Picibanil (OK-432) and bleomycin have been used as alternative sclerosing agents for lymphatic malformations. This study evaluated the clinical curative effect of sclerotherapy using fibrin glue combined with OK-432 and bleomycin for the treatment of macrocystic lymphatic malformations of the face and neck. Fifteen paediatric patients (6 males; 9 females, aged 13 months to 14 years) who had received percutaneous sclerotherapy for massive macrocystic lymphatic malformations of the face and neck were retrospectively reviewed. Affected regions included the neck, parotid region and parapharynx, mouth floor, face and cheek, and orbital regions. All patients showed preoperative symptoms of space-occupying lesions between 4 cm × 5 cm and 12 cm × 16 cm in size. Fibrin glue with OK-432 and bleomycin was injected under general anaesthesia. All patients received preoperative and follow-up CT scans. Outcomes were assessed by three surgeons. All patients exhibited mid-facial swelling for 3-4 weeks after surgery, but no major complications. Follow-up periods ranged from 8 to 16 months. Eight lesions were completely involuted, five were mostly involuted, and two were partially involuted. Percutaneous sclerotherapy using fibrin glue with OK-432 and bleomycin provided a simple, safe, and reliable alternative treatment for massive macrocystic lymphatic malformations of the face and neck.     

Hemodynamic changes in a patient with esophageal varices after endoscopic injection sclerotherapy evaluated by endoscopic color Doppler ultrasonography

A 46-year-old man with alcoholic cirrhosis was admitted to our hospital for treatment of high-risk esophageal varices in February 2000. Images of the esophageal varices, paraesophageal veins and palisade veins were obtained by endoscopic color Doppler ultrasonography (ECDUS) before endoscopic injection sclerotherapy (EIS). Prophylactic EIS was performed six times per week for esophageal varices, and EIS was continued until the esophageal varices were completely eradicated. In July 2002, endoscopy revealed esophageal varices graded as Cb, F1, Lm, and RC(−), and color flow images of the palisade veins (hepatofugal flow), esophageal varices, and a developed paraesophageal vein were obtained with ECDUS. In April 2003, endoscopy showed esophageal varices graded as Cb, F1, Lm, and RC(−), and color flow images of the palisade veins and esophageal varices were obtained using ECDUS. The blood in the palisade veins flowed in an alternate direction on color flow images, and pulsatile waves were delineated at the gastroesophageal junction. In January 2004, endoscopy revealed esophageal varices graded as F0 and RC(−), and pulsatile waves were delineated in the lower esophagus with ECDUS. However, the esophageal varices and palisade veins had disappeared from color flow images. In conclusion, ECDUS was useful for evaluating hemodynamic changes after EIS.     

人体包虫病的超声引导经皮穿刺硬化治疗

本文总结了人体多脏器多部位的包虫病８６例１０９个肿物在超声引导和监视下经皮穿刺硬化治疗的经验。其中，囊型包虫病８３例１０５个肿物，泡型包虫病３例４个肿物。穿刺成功率１００％。穿刺治疗总有效率１００％，（治愈率８３．７２％）。无一例出现过敏性休克、出血、感染等严重并发症。穿刺术后超声随访观察最长的已逾４２个月，平均２３个月，未发现穿刺针道和其它脏器或部位播散移植的任何迹象，亦无一例复发。结果认为，超声引导经皮穿刺硬化治疗肝脾等脏器和腹腔等部位的各型包虫病简便易行，安全实用，创伤甚微，疗效可靠，是一种基本上可替代传统手术疗法的新途径。