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.

Techniques and curative effects of fluoroscopy-guided foam sclerotherapy for lower extremity varicosities

Objective To describe the techniques of fluoroscopy-guided foam sclerotherapy for lower extremity varicosities, and evaluate the feasibility, safety and curative effects of it. Methods From October 2008 to December 2009, a total of 21 legs in 16 patients with lower extremity varicosities received radiological-guided foam sclerotherapy. They were enrolled in this study. Sodium morrhuate was foamed with by the filling-defects technique under fluoroscopy guidance. Postoperative compression was maintained for 2 weeks. Clinical effect was assessed as full success, partial success and no success. Complications were classified as minor or serious. Results The technical procedure was successful in all foam sclerotherapies for 21 legs. And, a single sclerotherapy session was adequate for all legs. The median follow-up period was 6. 0 months after treatment, ranged from 3.0 to 17.0 months. In this period, Clinical effect was assessed as full success for 17 legs (81.0%) and partial success for 4 legs ( 19.0% ). All patients presented selflimiting minor complications, including cordlike subcutaneous indurations along the treated veins (21 cases), skin hyperpigmentation in 11 legs (8 cases), local pain in 7 legs (6 cases) and superficial thrombophlebitits in one leg ( 1 case). No serious complications or systemic events occurred. Conclusion Fluoroscopy-guided foam sclerotherapy was a feasible, safe and effective treatment for lower extremity varicosities.