CAJ | 학술논문

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。
목적：비교량충불동도경주사1%취계순포말제치료대은정맥곡장적림상효과。방법2010년12월-2012년12월수치진단명학적하지정맥곡장환자80례，수궤분위X선투시하직접천자곡장정맥원심단주사1%취계순포말제（순행조，40례）급경근심단천자치관주입1%취계순포말제（역행조，40례）량조。기록량조환자적수술시간、술후회복시간、경화제용량、치료병발증、시부보충치료급수방결과。결과량조치료후3～6개월적림상총체료효차이무통계학의의（P>0.05）；순행조치료전림상-병인-해부-병리분급（CEAP）분수위3.70±0.63，치료후위0.88±1.18；역행조치료전CEAP분수위3.73±0.59，치료후위0.88±1.27，량조치료전후비교차이균유통계학의의（P<0.05），단조간비교차이무통계학의의（P>0.05）；단재수술시간、술후회복시간、경화제용량、수요보충치료인차등방면차이유통계학의의。결론채용X선투시인도하순행화역행량충방법주사취계순포말경화제치료하지정맥곡장총체료효상당，각유우결점，응근거불동환자정황채취개체화치료방안。
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 anterograde group and retrograde group (P < 0.05). Besides, the differences in the operation time, recovery time, the dosage of the sclerosing agent used, the incidence of complications 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.