下肢静脉曲张的诊断和手术方式

Diagnosis and Surgical Interventions for Varicose Veins in the Lower Extremities

摘要: 下肢静脉曲张(VV)是一种常见疾病，表现为下肢的静脉扩张和曲张，通常伴随有疼痛、肿胀和不适等症状。该疾病的发生与多种因素有关，包括遗传、性别、年龄、肥胖和久站等。在诊断静脉曲张时，临床医生通常会考虑多种因素，包括患者的病史、体格检查和影像学检查。影像学检查在VV的诊断中起着关键作用，常用的影像学检查方法包括彩色多普勒超声、数字减影血管造影(DSA)、计算机断层扫描静脉成像(CTV)和磁共振静脉成像(MRV)，需根据病人具体情况选择检查方式。VV的治疗方法包括保守治疗和手术治疗。保守治疗通常采用压迫疗法和药物治疗，旨在缓解症状和改善生活质量。手术治疗包括大隐静脉高位结扎、剥脱等外科手术、内源性激光消融(EVLA)、射频消融(RFA)、泡沫硬化疗法(UGFS)、和胶粘疗法(氰基丙烯酸酯粘合)等方式，这些方法可有效切除或阻止反流的隐静脉，进而缓解静脉功能不全症状，因其各自的优势均有广泛应用。VV诊断方式及手术方式的选择仍存在一些争议，需要进一步研究达成共识。

Abstract: Varicose veins (VV) of the lower extremities represent a prevalent medical condition characterized by the dilation and varicosity of veins in the lower limbs, frequently accompanied by symptoms such as pain, swelling, and discomfort. The etiology of this condition is multifactorial, with contributing factors including genetic predisposition, gender, age, obesity, and prolonged periods of standing. The diagnostic process for varicose veins typically involves a comprehensive assessment by the clinician, incorporating the patient’s medical history, physical examination, and relevant imaging studies. Imaging is integral to the diagnosis of varicose veins (VV), with frequently employed modalities including color Doppler ultrasound, digital subtraction angiography (DSA), computed tomography venography (CTV), and magnetic resonance venography (MRV). The selection of these imaging techniques is tailored to the individual patient. The management of VV encompasses both conservative and surgical approaches. Conservative management typically involves the use of compression therapy and pharmacological interventions aimed at alleviating symptoms and enhancing quality of life. Surgical interventions for venous insufficiency encompass a range of procedures, including high saphenous vein ligation, stripping, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), and cyanoacrylate adhesive closure. These techniques are efficacious in eliminating or halting reflux in saphenous veins, thereby alleviating the symptoms associated with venous insufficiency. Their widespread adoption is attributed to the distinct advantages each method offers. The selection of diagnostic and surgical approaches for varicose veins continues to be a subject of debate, necessitating additional research to achieve a consensus.