泡沫硬化剂（聚多卡醇）对曲张大隐静脉的病理损伤

Pathological effect of foam sclerotherapy （poUdocanol） on varicose great saphenous vein

目的观察泡沫硬化剂（聚多卡醇）最佳起效时间和最低起效浓度，以及聚多卡醇在不同浓度和不同时间对静脉壁所造成的病理变化的影响。方法取直径为5～10mm的曲张大隐静脉主干近心端。将静脉分割成长度为1cm的静脉段。各静脉段分别放置于不同浓度的聚多卡醇泡沫硬化剂中（0．5％、1．0％、3．0％），处理不同时间（1、10、30S、1、5、10min）。将对照组静脉段置于生理盐水中未做任何处理。最后将药物处理后及对照组的静脉段送病理切片检查。病理结果评价包括内膜坏死程度、内皮肿胀、内膜增厚、中膜水肿、平滑肌液化。最后得出评分采用统计学方法得出结论。结果聚多卡醇泡沫硬化剂组总得分明显高于对照组（P=0．025）。3％聚多卡醇组总损伤得分最高[（3．35±1．44）分，P=0．043]，差异有统计学意义；0．5％和1．0％聚多卡醇之间总损伤评分P=0．287，差异无统计学意义。以时间为变量的各组间差异，10rain组总损伤评分最高。除实验组1s与对照组总损伤评分之间P=0．585，差异无统计学意义外，实验组10、30S、1、5、10min与对照组的总损伤评分之间P=0．012，差异有统计学意义；其中30s、1、5、10min4组之间总损伤评分（P30s比1min=0．745，P30s比5min=0．071，P=30s比10min0．065，P1min比5min=0．752，P1min比10min=0．422，P5min比10min=0．883），差异无统计学意义。结论即使是最低浓度0．5％聚多卡醇，也能对静脉壁造成明显的病理变化，3％聚多卡醇的作用效力较0．5％和1．0％的聚多卡醇更为明显。聚多卡醇在作用30s后进入平台期，虽然1、5、10min的总损伤评分逐渐递增，但差异无统计学意义。建议在对曲张静脉注射泡沫硬化剂时，保持压迫曲张静脉近心端至少30s，以保证泡沫硬化剂于曲张静脉的充分接触及发挥硬化效力。

Objective The aim of this study was to investigate the minimum acting time and concentration of widely used foam sclerosant （polidocanol） as well as its histopathologieal effect on varicose great saphenous vein. Methods Varicose vein segments of 5 - 10 mm diameter were gently resected and exposed to various concentrations of polidocanol foam sclerosant （0. 5% , 1.0% , 3.0% ） for various time （ 1, 10, 30 s, 1, 5, 10 min）, and were then prepared for routine histopathologieal examination. A damage scoring system, including the presence of endothelial swelling, intimal thickening, cellular vacuolization in the muscle layer, edema in the tunica media and extent of necrosis, was established. Results The total damage score of the pofidocanol groups was significantly higher than that of the control group （P = 0. 025 ）. the highest damage score was achieved by 3% polidocanol （3.35 ＋ 1.44, P = 0. 043 ）. The highest damage score was achieved by 10 min regarding the variables of time. No significant difference was found among the 0. 5% and 1% concentrations of polidocanol. There was no significant difference between 1 s and control group （ P = 0. 585 ）. In addition, the total damage score of the group of 30 s, 1 rain , 5 min and 10 min was not significant in statistics （P30 lmin = 0. 745 ,P30 s vs.5min=-0. 071,P = 30s vs.10min 065, P1 min vs. 5min = 0. 752, P1 min vs 1 min = 0. 422, P5 min vs. 10 min = 0. 883 ）. Conclusion Significant pathological damage can be caused by even the lowest dose of polidocanol （0. 5% ）. The most injurious concentration was found to be 3% polidocanol morphologically. The effect of polidocanol stepped into platform 30 s after onset. There was no significant difference between groups of 1,5, 10 min, although the total damage score increased gradually. Further in vivo studies are needed to validate these findings.