慢性盆腔疼痛(CPP) 慢性盆腔疼痛约占门诊妇科就诊的10%，占腹腔镜诊断的1/3 慢性盆腔疼痛 30% 无法解释，对诊断和治疗都有挑战 盆腔静脉曲张存在于高达30%的妇女不明原因的慢性盆腔疼痛 高达20%的下肢静脉曲张患者部分或全部源自骨盆 【Asciutt 2009；Bora 2012】 慢性盆腔疼痛的鉴别诊断盆腔充血综合征(PCS)是一种疾病临床综合征- 有特殊的解剖表现， - 慢性盆腔疼痛持续6个月以上， - 继发于盆腔静脉功能不全，并伴有盆腔静脉扩张 >约占所有CPP的10-20% >旧定义
BASIC ANATOMY
Pelvic veins and lower extremities veins form a functional unit resulting in the interaction of their pathology
 Kamina P, et al. Phlebologie 1989 isolated SCP with Superficial Chronic Venous Insufficiency (SCVI) Grading of PCS？imaging classification in practice → to plan procedure
Imaging classification in practice → to plan the procedure
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Thin-walled, unsupported veins
- Lack of valves (up to 16% on the left), even less in IIV (Ahlberg NE, et al. Acta Radiol Diagn 1966)
- Abnormalities in collagen
- hormonal and hemodynamic factor related to pregnancy
- smooth muscle layer in OV undergoes age related thinning - reduced contractility
-Venous outflow obstruction “nutcracker phenomenon"
-Pregnancy
-Pregnancy
-Gravity
-Upright position
三个因素都 Increase of intraluminal pressure
三个因素都 Increase of intraluminal pressure
Oklu R, et al. J Vasc Interv Radiol 2012
有人将盆腔静脉淤血按血流速度分为两型
Type I Low-flow pelvic varicocele 低速盆腔静脉曲张
a. Non-cross-pelvic. 非跨越盆腔
b. Cross-pelvic. 跨越盆腔
Type II High-flow pelvic varicocele 高速盆腔静脉曲张
a. Non-cross-pelvic (high-outflow through the ipsilateral hypogastric vein). 非跨越盆腔（通过同侧的髂静脉）
b. Cross-pelvic varicocele 跨越盆腔静脉曲张
1. High-outflow through the contralateral hypogastric vein. 通过对侧髂内静脉的高血流
2. High-outflow through both hypogastric veins. 双侧前内静脉高血流
3. High-outflow through the contralateral ovarian vein. 通过对侧卵巢静脉高血流
4. High-outflow through all of the above veins. 通过以上所有静脉的高血流
1. Adams et al., Br J Obstet Gyn 1990