泡沫硬化治疗下肢静脉曲张的研究

Study on Foam Sclerotherapy in Treatment of Varcose Vein of Lower Limb

目的 探讨泡沫硬化剂与传统的大隐静脉高位结扎并抽剥术治疗下肢静脉曲张的疗效差异。方法65例下肢静脉曲张患者（72条患肢），按照治疗方法分为泡沫硬化剂组（50条患肢）和传统手术治疗组（22条患肢）。分析2组血管直径、并发症（如深静脉血栓、肺栓塞、荨麻疹、红肿硬结、色素沉着，视盲等），住院时间、行走功能恢复、疤痕率以及复发率等项目。结果泡沫硬化剂组（50条患肢）无严重并发症发生，治疗部位初期均有不同程度红肿，经穿压力梯度弹力袜行走后可自行消失；全身荨麻疹1例，激素治疗1个月后消失；色素沉着3例，用维生素E精华素霜涂抹3个月后消失；7条（7／50）（血管直径〉6mm）患肢于治疗后3～6个月复诊时实施了第2次治疗，所有患者治疗后均能立即行走，未出现过深静脉血栓形成，2例治疗过程中出现胸闷气急，休息30min后完全恢复，未出现暂时性视盲，未出现隐神经损伤后的表皮麻木感，表面无疤痕出现。传统手术治疗组复发的6例，经泡沫硬化剂注射治疗也取得了良好的效果，其余患者未出现复发症状。结论泡沫硬化剂注射治疗直径6mm以下的静脉曲张或传统手术复发的静脉曲张，效果好、复发率低、并发症少，并且该方法操作简便、痛苦小、无疤痕形成、可重复性好，多不用住院，是一种治疗与美容兼备的微创治疗方法。但治疗前应仔细询问药物过敏史，特别是对酒精过敏史，防止出现全身荨麻疹，对粗大的静脉曲张建议行手术或激光治疗，可联合泡沫硬化剂注射治疗预防复发。

Objective To study the efficacy of foam sclerotherapy vs conventional operation in treatment of varcose vein of lower limb. Methods We retrospectively analyzed 65 patients with 72 limbs of varicose veins treated with 6 -18 months follow -upmean 12 months）, and analyzed the curative effect and technology of two methods, in particular that of foam sclerotherapy in treatment of varcose vein of lower limb. Based on different treatments, we divided them into two groups： foam sclerotherapy group （50 limbs ） and traditional surgery group（ 22 limbs）. Statistical indicators included vessel diameter, complications （such as deep venous thrombosis, pulmonary embolism, urticaria, phlebitis, pigmentation, blindness, etc）, Days of admission, walking function, scarring rate and recurrence rate. Results Satisfactory results were achieved by foam sclerotherapy without serious complications,redness and swelling can fade away on their own by wearing medical elastic socks. 1 case of general urticaria occurred and was treated with hormone for one month and 3 cases of pigmentation occurred and disappeared after three months using the capsule of vitamin E essence. Further foam sclerotherapy was carried out again for 7 （7/50） patients （ Vessel diameter 〉 6 mm） at 3 -6 months after the first therapy. All patients could walk immediately with no deep vein thrombosis, no neurological deficit, no scarring, but only one patient presented chest tightness and recovered completely after half an hour without any treatment. 6 recurrence cases of conventional operation had been also achieved good results using foam sclerotherapy. At the time of press, recurrence had not been observed among the remaining patients. Conclusion Foam sclerothera- py showed better results for the treatment of varicose vein of less than 6mm diameter and recurrence varicose vein of conventional operation, and was safe and effective with low recurrence rate, less pain, no scarring and good repeat- ability. Foam sclerotherapy is both a minimally invasive and cosmetic treatment. However, patients should be asked in detail about the history of drug allergy, especially allergic to alcohol, before Foam sclerotherapy treatment. We suggest larger varicose veins shuold be treated with the endovenous laser therapy or conventional surgery. Foam sclerotherapy can be used to treat recurrence case.