概论 适应症和禁忌症 术前准备 技术上的考虑 盆腔充血综合症介入治疗的结果 术后护理 并发症介入治疗小结
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盆腔淤血综合症:小结和争论

时间:2023-11-03 14:13来源:www.ynjr.net 作者:杨宁介入医学网
1. 下肢静脉曲张和盆腔静脉曲张(卵巢和髂内静脉) (1)两者都治疗?还是分期治疗。 Should both OVs and the IIVs be embolized? (2)先治疗哪一个?盆腔静脉曲张优先,还是下肢?或者没关系(does it matter?) 2. 影响生育吗?(Impact on fertility)

1. 下肢静脉曲张和盆腔静脉曲张(卵巢和髂内静脉)

(1)两者都治疗?还是分期治疗。

         Should both OVs and the IIVs be embolized?

(2)先治疗哪一个?盆腔静脉曲张优先,还是下肢?或者没关系(does it matter?)


2. 影响生育吗?(Impact on fertility)


3. 关于卵巢静脉栓塞


(1)仅栓塞症状一侧,然后等着看(wait and see)

(2)最初就一侧性栓塞双侧卵巢静脉?

(3)球囊阻塞 vs 选择性导管?

(4)股,贵要和颈静脉途径?

(5)栓塞剂的选择

          选择弹簧栓子、血管塞、液体硬化剂/ 类型? 液体栓塞剂 vs 泡沫硬化剂?硬化剂+明胶海绵?联合治疗(如硬化剂+弹簧栓子)

          What embolization material should be used (coils, sclerosants, glue, or gelfoam)?

4. 关于髂内静脉栓塞

  (1)治疗还是不治疗

  (2)如果治疗,球囊阻塞还是选择性导管技术,路径如何?

   (3)不治疗,等待卵巢静脉栓塞的临床反应

  (4) 用硬化剂吗? 泡沫?硬化+明胶海绵?仅用弹簧栓子?联合治疗?

     血管内栓塞导致PVD的临床改善(VAS评分),并没有关于不同方法的随机临床试验。SVP分类有助于前瞻性随机试验的设计和证据的产生。对于由May-Thurner 综合征(MTS)和胡桃夹综合征(NCS)引起的盆腔静脉疾病(PVD): 治疗潜在的解剖原因


- Consider the clinical background (limb varices)
- Embolise as many refluxing veins as possible
- Offer this treatment as the less invasive and the most effective one
- We need more evidence



What’s New In Pelvic Congestion?

• Continues to be haunted by lack high quality evidence
• No universally accepted dx criteria
• Roughly 75% patients symptomatic relief
• Aggressive interrogation of IIV’s
• Obstructive component more recognized
• No “best”
     – Technique
     – Embolic agent


CONCLUSIONS

-Phlebography of four vessels if possible
-Embolisation as many refluxing veins as possible
-Choose your embolic material and end-point (combination?)
-Offer this treatment as the most effective with at least 80% of success
 

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