Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.     

Transcatheter Ovarian Vein Embolization Using Coils for the Treatment of Pelvic Congestion Syndrome

Purpose To evaluate the therapeutic effectiveness of ovarian vein embolization using coils for pelvic congestion syndrome (PCS), a common cause of chronic pelvic pain in multiparous women. Methods Between November 1998 and June 2005, 67 patients were diagnosed with PCS and underwent ovarian vein coil embolization. Through medical records and telephone interviews, the pre-embolization pain level and post-embolization pain control were assessed. In addition, in those cases where pain persisted after embolization or where patients were dissatisfied with the procedure, additional treatments and subsequent changes in pain scores were also analyzed. Evaluation after coil embolization was performed within 3–6 months (n = 3), 6 months to 1 year (n = 7), 1–2 years (n = 13), 2–3 years (n = 7), 3–4 years (n = 7), 4–5 years (n = 13), or 5–6 years (n = 17). Results Among a total of 67 patients, 82% (55/67) experienced pain reduction after coil embolization, were satisfied with the procedure, and did not pursue any further treatment. Twelve patients (18%, 12/67) responded that their pain level had not changed, or had become more severe. Among them, 9 patients were treated surgically and the remaining 3 patients remained under continuous drug therapy. Conclusion Ovarian vein embolization using coils is a safe and effective therapeutic method for treatment of PCS. It is thought that surgical treatment should be considered in cases where embolization proves ineffective.     

盆腔淤血综合征的介入诊断与治疗

目的 探讨盆腔淤血综合征(PCS)的介入诊断与治疗效果.资料与方法 采用选择性卵巢静脉造影术,分别对15例临床怀疑为PCS患者进行选择性卵巢静脉造影,在造影明确诊断PCS后,进一步选择性插管,同时用23枚弹簧圈完全栓塞卵巢静脉.结果 15例卵巢静脉造影显示均有不同程度的卵巢静脉丛迂曲扩张,管腔直径达832 mm,14例静脉廓清时间≥20 s,1例<20 s,15例造影后均行卵巢静脉栓塞术,术后27天腹痛症状明显缓解或消失.结论 选择性卵巢静脉造影术是诊断PCS的可靠方法,同时便于栓塞治疗,选择性卵巢静脉栓塞治疗快捷、微创、疗效确切.     

Pelvic Congestion Syndrome: Etiology of Pain,Diagnosis, and Clinical Management

Pelvic congestion syndrome is associated with pelvic varicosities that result in chronic pelvic pain, especially in the setting of prolonged standing, coitus, menstruation, and pregnancy. Although the underlying pathophysiology of pelvic congestion syndrome is unclear, it probably results from a combination of dysfunctional venous valves, retrograde blood flow, venous hypertension, and dilatation. Asymptomatic women may also have pelvic varicosities, making pelvic congestion syndrome difficult to diagnose. This article explores the etiologies of pain, use of imaging techniques, and clinical management of pelvic congestion syndrome. Possible explanations for the spectrum of pain among women with pelvic varicosities are also discussed.     

盆腔静脉血管造影诊断女性静脉瘀血综合症(附67例报告)

目的 对盆腔静脉形态、走向,瘀血症形成机理及诊断价值进行探讨。材料与方法 ６７例经宫底穿刺作静脉血管造影。８例尸解标本,对正常和异常的盆腔静脉形态学和血液动力学进行比较分析。结果 ６７例诊断为静脉瘀血症,轻型３４例（其中结扎术后１５例。占４４．１％）,中型３０例（结扎术后２１例,占７０％）,重型３例（均为结扎术后）。结扎术后发生率占本组５８．２％。结论 盆腔静脉血管造影能为临床诊断瘀血症提供可靠的     

A Randomized Trial of Endovascular Embolization Treatment in Pelvic Congestion Syndrome: Fibered Platinum Coils versus Vascular Plugs with 1-Year Clinical Outcomes

Purpose

To compare safety and efficacy of vascular plugs (VPs) and fibered platinum coils (FPCs) for embolization in pelvic congestion syndrome (PCS).

Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

Purpose

We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms.

Materials and Methods

We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients who had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3 months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6 months after embolization. Paired Student t test analysis was used for comparing data before and after embolization.

Results

Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p < 0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6 months. There was also significant (p < 0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3 months after embolization.

Conclusion

Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.     

Coil Protruding into the Common Femoral Vein Following Pelvic Venous Embolization

Pelvic venous embolization is performed for pelvic congestion syndrome and prior to lower limb varicose vein surgery in females with associated pelvic venous insufficiency. The procedure is analogous to varicocele embolization in males, although refluxing internal iliac vein tributaries may also be embolized. We report a case of inadvertent coil placement in the common femoral vein while embolizing the obturator vein, during pelvic vein embolization for recurrent lower limb varicose veins. There were no clinical consequences and the coil was left in situ. We advise caution when embolizing internal iliac vein tributaries where there is clinically significant communication with veins of the lower limb.     

腔内激光处理联合大隐静脉高位结扎治疗下肢深静脉功能不全的疗效评价

目的评价腔内激光处理联合大隐静脉高位结扎治疗下肢深静脉功能不全的疗效。方法下肢浅静脉曲张患者64例75条肢体,根据术前股浅静脉第一对瓣膜反流时间长短分为轻度反流(40条)、重度反流两组(35条)。所有病例均采用浅静脉腔内激光处理联合大隐静脉高位结扎治疗。比较术前与术后4～6个月的反流时间,以临床-病因-解剖-病理生理(clinical-etiological-anatomical-pathophysiological,CEAP)修正法临床症状评分法评价治疗效果。结果术后反流时间的变化:轻度反流组术后反流时间小于0.5s者26例,治愈率65.0%,好转11例,总有效率92.5%。重度反流组术后反流时间小于0.5s者7例,治愈率20.0%,有效24例,总有效率88.5%,无效4例。所有病例临床症状评分均明显下降。结论腔内激光处理联合大隐静脉高位结扎治疗下肢深静脉功能不全疗效确切,但对于深静脉重度反流者应加行深静脉重建手术。     

输卵管结扎术后盆腔静脉瘀血综合征的X线造影表现及其诊断价值

目的 :探讨对输卵管结扎术后盆腔静脉瘀血综合征形成机理及X线造影诊断价值。材料和方法 :69例经宫底穿刺作静脉血管造影 ,对正常和异常的盆腔静脉造影表现作了对比分析。结果 :48例 ( 69 6% )诊断为盆腔静脉瘀血综合征 ,轻型 18例 ( 3 7 5 % ) ,中型 2 4例 ( 5 0 0 % ) ,重型 6例 ( 12 5 % ) ,2 1例 ( 3 0 4% )正常。结论 :盆腔静脉血管造影是一种简单、安全的诊断方法 ,可以为临床提供客观的血液动力学及形态学诊断依据。     

少年舞蹈体操学员骨盆的骨与关节损伤

目的 探讨少年舞蹈体操学员髋关节与骶髂关节及坐骨结节骨骺损伤情况。资料与方法 60例10-16岁少年学员，平均年龄12．5岁，男29例，女31例。其中从事训练1年者35例，接受训练2年者25例。60例均摄正位骨盆x线片，以观察少年舞蹈体操学员骨盆的异常改变。结果 骨盆正位X线片显示：最明显的变化是坐骨结节骨骺的撕脱骨折、分离与干骺端增生硬化(25％)，坐骨结节外上缘皮质吸收(46．7％)，骨骺正常或未出现(21．7％)。此外还包括骨骺终板中心硬化(60％)，髋关节出现真空(31．7％)、狭窄或稍窄以及髋臼顶增生硬化等。骶髂关节面模糊破坏、凹凸不平硬化(26．7％)等。结论 少年舞蹈体操学员初期接受严格训练，运动量过大，容易造成骨盆损伤，应予以关注。     

Deep Pelvic Endometriosis

Teaching Point: Magnetic resonance imaging allows adequate evaluation of the location, size and subperitoneal lesion extension of deep pelvic endometriosis, providing key information for both the diagnosis and treatment planning.     

肾盂癌的诊断与治疗分析

目的探讨肾盂癌的诊疗方法,提高肾盂癌诊治水平。方法回顾分析21例肾盂癌的临床资料。结果 21例均行手术治疗,病理检查提示移行细胞癌19例,其中Gl级5例,G2级8例,G3级6例,低分化鳞癌2例;Ruben-stein分期:T1期8例,T2期7例,T3期4例,T4期2例。随防6月-7年,1年生存率80.9%,5年生存率61.9%,平均生存4.2年。结论 肾孟癌诊断主要靠临床表现及放射学检查,早期诊断、及时行根治性肾、输尿管全切除术是主要的治疗方法。