黄望星,华国勇

原发性下肢浅静脉曲张是一种常见的临床表现，其主要特征是静脉壁内无力，并伴有瓣膜功能障碍和静脉回流[1]。患者随着病情加重表现出一系列症状，包括腿部静脉突出、沉重、疼痛、瘙痒、肿胀、肌肉痉挛、变色和溃疡[2]。早期、中期会对生活质量造成一定影响，后期会丧失一定的劳动力。据报道，女性人群中下肢浅静脉曲张的患病率高达73%，男性人群中高达56%。与该疾病相关的各种风险因素包括女性性别、长时间站立/坐立、怀孕、职业（例如警察、农民、教师）、激素影响、肥胖、家族史和高龄[3]。对下肢静脉解剖学和生理学的良好和全面理解是有效治疗的保证。不同的治疗选择包括早期保守治疗、传统的外科治疗和较新的血管内治疗。血管内治疗包括泡沫硬化疗法、热消融和机械化学消融。原发性下肢浅静脉曲张有庞大的就诊和治疗需求，因此寻求一种或多种合理的治疗方式是十分必要的。本文就常用的诊断和治疗方式进行综述。

原发性下肢浅静脉曲张；腔内治疗

[1] Yetkin E,Ozturk S,Cuglan B,et al.Symptoms in dilating venous disease[J].Current Cardiology Reviews,2020,16(3):164-172. [2] Bissacco D,Pisani C.The Other Side of Chronic Venous Disorder:Gaining Insights from Patients’Questions and Perspectives[J].Journal of Clinical Medicine,2024,13(9):2539. [3] Elamrawy S,Darwish I,Moustafa S,et al.Epidemiological,life style,and occupational factors associated with lower limb varicose veins:a case control study[J].Journal of the Egyptian Public Health Association,2021,96:1-11. [4] Gawande V R,Mukhmale V S,Bhatkar V D,et al.Varicose veins:A systematic review of the diagnosis and treatment of varicose veins[J].2024. [5] CORREA POSADA M O,CONTRERAS CORREA L M,GARCíA VéLEZ J F.Factors associated with chronic venous disease:study in 1,136 patients treated for varicose veins of the lower limbs in a specialized clinic[J].Jornal Vascular Brasileiro,2022,21:e20220051. [6] 弓文清,徐晖,董洪娜,等.高频超声成像评估中青年下肢静脉曲张及危险因素[J].中国医学影像学杂志,2023,31(09):985-989. [7] 曾蕾,袁江,熊亮,等.三维CT静脉造影对静脉曲张患者下肢静脉系统解剖特点的评估价值[J].实用放射学杂志,2022(9):1443-1446. [8] SHAJDAKOV E,SANNIKOV A,EMELYANENKO V,et al.MRI-and CT-venography in the diagnosis of hemodynamic disorders in patients suffering from lower extremities chronic venous disorders.Part II.Possibilities of MRI in diagnostics of the deep vein thrombosis[J].Medical Visualization,2021,25(1):117-39. [9] POREDOŠP,SPIRKOSKA A,JEŽOVNIK M K.In patients with superficial vein thrombosis the inflammatory response is increased and related to the recanalization rate[J].Archives of Medical Science,2019,15(2):393-401. [10] Whiteley M S.Current best practice in the management of varicose veins[J].Clinical,Cosmetic and Investigational Dermatology,2022:567-583. [11] IAFRATI M D.Medical therapies for chronic venous insufficiency[J].Venous Ulcers,2023:261-82. [12] EGGEN C A,ALOZAI T,PRONK P,et al.Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation(980nm)using local tumescent anesthesia[J].Journal of Vascular Surgery:Venous and Lymphatic Disorders,2022,10(3):646-53.e1. [13] BELLMUNT-MONTOYA S,ESCRIBANO J M,BUSTILLOS P E P,et al.CHIVA method for the treatment of chronic venous insufficiency[J].Cochrane Database of Systematic Reviews,2021,(9). [14] 许玉春,李轶辉,吴润东,等.CHIVA手术与传统手术治疗大隐静脉曲张疗效比较[J].中国现代手术学杂志,2021,25(01):46-49. [15] 陈君辉,朱培菊,任毅,等.经内踝穿刺插管注射聚桂醇泡沫硬化剂治疗下肢静脉曲张疗效评价[J].实用放射学杂志, 2018,34(10):1588-1590. [16] 冯惠岗,李忠民,林桂仪,等.聚多卡醇泡沫硬化治疗下肢静脉曲张性溃疡的疗效观察[J].实用放射学杂志,2019,35(2):275-277. [17] SAKUGAWA L S,PORTELA F S O,LOUZADA A C S,et al.Polidocanol-foam treatment of varicose veins:Quality-of-life impact compared to conventional surgery[J].Clinics,2024,79:100346. [18] ROSS C B,CHAHWALA V,CRADDOCK G R.Ablative Techniques for Management of Symptomatic Superficial Venous Disease[J]. Surgical Anatomy and Technique:A Pocket Manual,2021:785-804. [19] HONG K-P.Midterm results of radiofrequency ablation with multiple heat cycles for incompetent saphenous veins[J].Journal of Vascular Surgery:Venous and Lymphatic Disorders,2023,11(3):483-7. [20] JIA W,LIU J,CHENG Z.Clinical efficacy of endovenous radiofrequency ablation(RFA)for superficial varicose veins of the lower extremities[J].Disease Markers,2022,2022(1):1673588. [21] Palombi L,Morelli M,Bruzzese D,et al.Third generation of laser(>1900)for endovenous thermoablation(EVLA)of varicose veins:A systematic review and meta-analysis[J].Phlebology,2024,39(5):293-301. [22] KUBAT E,ÜNAL C S,GELDI O,et al.What is the optimal treatment technique for great saphenous vein diameter of≥10 mm? Comparison of five different approaches[J].Acta Chirurgica Belgica,2021,121(2):94-101. [23] BARAM A,RASHID D F,SAQAT B H.Non-randomized comparative study of three methodsfor great saphenous vein ablation associated with mini-phlebectomy;48 months clinical and sonographic outcome [J].Annals of medicine and surgery,2022,80:104036. [24] Witte M E,Holewijn S,van der Veen D,et al.Long-term results and predictors of failure after mechanochemical endovenous ablation in the treatment of primary great saphenous vein incompetence [J].Phlebology,2024,39(1):9-19. [25] Holewijn S,van Eekeren R R J P,Vahl A,et al.Two-year results of a multicenter randomized controlled trial comparing Mechanochemical endovenous Ablation to RADiOfrequeNcy Ablation in the treatment of primary great saphenous vein incompetence (MARADONA trial)[J].Journal of Vascular Surgery:Venous and Lymphatic Disorders,2019,7(3):364-374. [26] Kwon Y W,Park S W,Hwang J H,et al.Feasibility and short-term complication rate of mechanochemical ablation for epifascial tributaries of incompetent great saphenous veins[J].Journal of Vascular Surgery:Venous and Lymphatic Disorders,2021,9(4):925-931. [27] Vähäaho S,Halmesmäki K,Mahmoud O,et al.Three-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins[J].Journal of Vascular Surgery:Venous and Lymphatic Disorders,2021,9(3):652-659.

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