聚桂醇泡沫硬化剂治疗下肢静脉曲张中两种不同注射途径的比较研究

Foam sclerotherapy of lauromacrogol for the treatment of lower extremity varicose veins: comparison study of two different injection ways

目的比较两种不同途径注射1％聚桂醇泡沫剂治疗大隐静脉曲张的临床效果。方法2010年12月-2012年12月收治诊断明确的下肢静脉曲张患者80例，随机分为X线透视下直接穿刺曲张静脉远心端注射1％聚桂醇泡沫剂（顺行组，40例）及经近心端穿刺置管注入1％聚桂醇泡沫剂（逆行组，40例）两组。记录两组患者的手术时间、术后恢复时间、硬化剂用量、治疗并发症、是否补充治疗及随访结果。结果两组治疗后3～6个月的临床总体疗效差异无统计学意义（P〉0．05）；顺行组治疗前临床-病因-解剖-病理分级（CEAP）分数为3．70±0．63，治疗后为0．88±1．18：逆行组治疗前CEAP分数为3．73±0．59，治疗后为0．88±1．27，两组治疗前后比较差异均有统计学意义（P〈0．05），但组间比较差异无统计学意义（P〉0．05）；但在手术时间、术后恢复时间、硬化剂用量、需要补充治疗人次等方面差异有统计学意义。结论采用X线透视引导下顺行和逆行两种方法注射聚桂醇泡沫硬化剂治疗下肢静脉曲张总体疗效相当，各有优缺点，应根据不同患者情况采取个体化治疗方案。

Objective To compare the clinical efficacy of two different injection ways in treating lower extremity varicose veins with foam sclerotherapy of lauromacrogol. Methods During the period from Dec. 2010 to Dec. 2012 a total of 80 patients with clinically-proved lower extremity varicosis were admitted to authors＇ hospital. The patients were randomly and equally divided into two groups： anterograde group （n = 40） and retrograde group （n = 40）. For patients of anterograde group, under fluoroscopy guidance the needle was directly punctured into the distal end of the varicose vein with subsequent injection of 1% lauromacrogol foam sclerosing agent, while for patients of retrograde group the opposite femoral vein was punctured by using Seldinger technique, then a catheter was inserted into the proximal part of the great saphenous vein of the diseased side, and 1% lauromacrogol foam sclerosing agent was injected into the varicose vein. The operation time, recovery time, the dosage of the sclerosing agent used, the incidence of complications and the use of additional treatment were recorded, and the results were statistically analyzed. All the patients were followed up for 3 - 6 months. Results No significant difference in the overall effective rate existed between the two groups at 3 - 6 months after the treatment （P 〉 0.05）. The preoperative and postoperative CEAP scores of the anterograde group were 3.70± 0.63 and 0.88± 1.18 respectively, while the preoperative and postoperative CEAP scores of the retrograde group were 3.73 ± 0.59 and 0.88 ± 1.27 respectively. The difference in CEAP score between preoperative values and postoperative ones was statistically significant in both anterogradegroup and retrograde group （P 〈 0.05）. Besides, the differences in the operation time, recovery time, the dosage of the sclerosing agent used, the incidence ofcomplications and the use of additional treatment between the two groups were also statistically significant. Conclusion In treating lower extremity varicose veins with foam sclerotherapy of lauromacrogol, the overall effectiveness of anterograde injection and retrograde injection is quite the same. As each injection way has its own advantages and disadvantages, the therapeutic scheme should be individualized for each patient. （J Intervent Radiol, 2014, 23： 392-396）