下肢静脉曲张病人卵圆孔未闭-右向左分流发生率的研究

外科理论与实践››2024,Vol. 29››Issue (06): 493-497.doi:10.16139/j.1007-9610.2024.06.06

下肢静脉曲张病人卵圆孔未闭-右向左分流发生率的研究

岑庆¹, 唐明珺²^,³, 朱越锋²^,⁴()

1.慈溪市人民医院普外科，浙江宁波 315300
2.浙江大学医学院附属第四医院血管外科，浙江义乌 322000
3.浙江大学国际健康医学研究院，浙江义乌 322000
4.浙江大学医学院附属邵逸夫医院血管外科，浙江杭州 310016

收稿日期:2024-10-14出版日期:2024-11-25发布日期:2025-03-17
通讯作者:朱越锋，E-mail:srrshzyf@zju.edu.cn
基金资助:
慈溪市公益类科技计划(CN2022003);浙江省中医药开云足球app官方下载安装基金(2011ZB079);浙江省医药卫生科技项目(2024KY1184)

The incidence of PFO-RLS in patients with varicose veins of the lower extremities

CEN Qing¹, TANG Mingjun²^,³, ZHU Yuefeng²^,⁴()

1. Department of General Surgery, Cixi People's Hospital, Zhejiang Ningbo 315300， China
2. Department of Vascular Surgery, the Fourth Affiliated Hospital, Zhejiang University School of Medicine， Zhejiang Yiwu 322000, China
3. International Institutes of Medicine, Zhejiang University，Zhejiang Yiwu 322000, China
4. Department of Vascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310016, China

Received:2024-10-14Online:2024-11-25Published:2025-03-17

摘要/Abstract

摘要：

目的：研究评价下肢静脉曲张病人卵圆孔未闭(PFO)-心内右向左分流(RLS)的发生率。方法：2023年3月至2024年8月期间连续入住慈溪市人民医院下肢静脉曲张病人86例，其中57例同意行泡沫硬化剂治疗，术前行PFO-RLS检查。结果：57例中，PFO 23例，发生率为40.4%（95% CI: 27.2%~53.5%），心内RLS 22例，发生率为38.6%（95% CI: 25.6%~51.6%）。PFO发生率高于所报道的普通人群26%。所有病人术后均无肺栓塞、卒中等严重并发症发生。结论：下肢静脉曲张病人PFO-RLS的发生率高于普通人群的预期水平。下肢静脉曲张病人在选择硬化剂治疗的时候需警惕相关神经系统并发症。

关键词:静脉曲张,硬化剂治疗,卵圆孔未闭,右向左分流

Abstract:

ObjectiveTo study and evaluate the incidence of patent foramen ovale（PFO） and intracardiac right-to-left shunt（RLS）in the patients with varicose veins of the lower extremities.MethodsFrom March 2023 to August 2024, 86 consecutive patients with varicose veins of the lower extremities were admitted to Cixi People’s hospital, and 57 of them who agreed to take foam sclerotherapy were selected for PFO-RLS test.ResultsOf the 57 patients, a total of 23 patients were positive for PFO with an incidence of 40.4% (95% CI: 27.2%-53.5%) and a total of 22 patients were positive for RLS with an incidence of 38.6% (95% CI: 25.6%-51.6%). The incidence of PFO was higher than the reported incidence in the general population, which is 26%. There were no serious complications such as pulmonary embolism or stroke occurred in all patients after surgery.ConclusionsThe incidence of PFO-RLS in patients with varicose veins of the lower extremities in this study was higher than that of expected in the general population. Patients with lower extremity varicose veins should be aware of the associated neurological complications when choosing sclerotherapy.

Key words:Varicose vein,Sclerotherapy,Patent foramen ovale(PFO),Right-to-left shunt(RLS)

中图分类号:

R543.6
R541

岑庆, 唐明珺, 朱越锋. 下肢静脉曲张病人卵圆孔未闭-右向左分流发生率的研究[J]. 外科理论与实践, 2024, 29(06): 493-497.

CEN Qing, TANG Mingjun, ZHU Yuefeng. The incidence of PFO-RLS in patients with varicose veins of the lower extremities[J]. Journal of Surgery Concepts & Practice, 2024, 29(06): 493-497.

图/表1

Item	PFO (n=23)	Normality (n=34)	t/χ² value	Pvalue
Gender (male/female)	16/7	22/12	0.146	>0.05
Age（years）	55.57±12.40	57.74±11.56	-0.675	>0.05
Operating time (min)	63.04±7.50	50.29±8.16	5.976	<0.05
Intraoperative blood loss（mL）	70.87±14.67	27.21±11.16	12.103	<0.05
Postoperative complication	2	2	0	>0.05

参考文献18

[1]	FORLEE M V, GROUDEN M, MOORE D J, et al. Stroke after varicose vein foam injection sclerotherapy[J].J Vasc Surg,2006,43(1):162-164. doi:10.1016/j.jvs.2005.09.032pmid:16414404
[2]	KIM M, NIROUMANDPOUR M, POUSTINCHIAN B. Transient ischemic attack after foam sclerotherapy in a woman with a patent foramen ovale[J].J Am Osteopath Assoc,2016,116(5):320-323. doi:10.7556/jaoa.2016.063pmid:27111786
[3]	ABDELHAMID N, FAROOQ S, SARRAJ A. Acute is-chemic stroke in a young woman with no known risk factors[J].WMJ,2018,117(1):42-44.
[4]	HOMMA S, SACCO R L. Patent foramen ovale and stroke[J].Circulation,2005,112(7):1063-1072. pmid:16103257
[5]	WRIGHT D D, GIBSON K D, BARCLAY J, et al. High prevalence of right-to-left shunt in patients with sympto-matic great saphenous incompetence and varicose veins[J].J Vasc Surg,2010,51(1):104-107.
[6]	GAJO E C, KAVINSKY C J, MURPHY J, et al. The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations[J].Eur Heart J Case Rep,2021,5(8):ytab228.
[7]	BAHTIRI L, THOMSEN A V, ASHINA M, et al. Migraine aura-like episodes following sclerotherapy for varicose veins of the lower extremities—a systematic review[J].Headache,2023,63(1):40-50.
[8]	DE MAESENEER M G, KAKKOS S K, AHERNE T, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs[J].Eur J Vasc Endovasc Surg,2022,63(2):184-267.
[9]	GUEX J J, ALLAERT F A, GILLET J L, et al. Immediate and midterm complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions[J].Dermatol Surg,2005,31(2):123-128.
[10]	Gillet J L, Guedes J M, Guex J J, et al. Side-effects and complications of foam sclerotherapy of the great and small saphenous veins: a controlled multicentre prospective study including 1,025 patients[J].Phlebology,2009,24(3):131-138. doi:10.1258/phleb.2008.008063pmid:19470865
[11]	RABE E, BREU F X, CAVEZZI A, et al. European guidelines for sclerotherapy in chronic venous disorders[J].Phlebology,2014,29(6):338-354. doi:10.1177/0268355513483280pmid:23559590
[12]	GIBSON K, KABNICK L. A multicenter, randomized, placebo-controlled study to evaluate the efficacy and safety of Varithena^®(polidocanol endovenous microfoam 1%) for symptomatic, visible varicose veins with saphenofemoral junction incompetence[J].Phlebology,2017,32(3):185-193.
[13]	REGAN J D, GIBSON K D, RUSH J E, et al. Clinical significance of cerebrovascular gas emboli during polidocanol endovenous ultra-low nitrogen microfoam ablation and correlation with magnetic resonance imaging in patients with right-to-left shunt[J].J Vasc Surg,2011,53(1):131-137. doi:10.1016/j.jvs.2010.06.179pmid:20864303
[14]	中华医学会外科学分会血管外科学组. 硬化剂治疗下肢静脉曲张(中国)专家指导意见(2016)[J].中国血管外科杂志(电子版),2017,9(1):11-14,26.
	Vascular Surgery Group, Chinese Society of Surgery, Chinese Medical Association. Expert guidance on sclerotherapy for varicose veins of the lower extremities (China) (2016)[J].Chin J Vasc Surg(Electronic Version),2017,9(1):11-14,26.
[15]	中华医学会外科学分会血管外科学组, 中国医师协会血管外科医师分会, 中国医疗保健国际交流促进会血管外科分会, 等. 中国慢性静脉疾病诊断与治疗指南[J].中华医学杂志,2019,99(39):3047-3061.
	CSSG, CAVS, CPAM, et al. Guidelines for the diagnosis and treatment of chronic venous diseases[J].Natl Med J China,2019,99(39):3047-3061.
[16]	中国微循环学会周围血管疾病专业委员会. 聚桂醇注射液治疗下肢静脉曲张微循环专家共识[J].血管与腔内血管外科杂志,2020,6(5):377-381.
	Chinese Society of Microcirculation & Professional Committee of Vascular Disease. Expert consensus on lauromacrogol injection in the treatment of microcirculation of varicose vein of lower limb[J].J Vasc Endovasc Surg,2020,6(5):377-381.
[17]	中国微循环学会周围血管疾病专业委员会. 原发性下肢浅静脉曲张诊治专家共识(2021版)[J].血管与腔内血管外科杂志,2021,7(7):762-772.
	Peripheral Vascular Disease Committee of Chinese Socie-ty of Microcirculation. Expert consensus on the diagnosis and treatment of primary superficial varicose veins of the lower extremity (2021 edition)[J].J Vasc Endovasc Surg,2021,7(7):762-772.
[18]	中国医师协会血管外科医师分会静脉学组. 常见静脉疾病诊治规范(2022年版)[J].中华血管外科杂志,2022,7(1):12-29.
	Chinese Society of Vascular Surgery, Chinese Medical Doctor Association. Diagnosis and treatment standard of common venous diseases (2022 version)[J].Chin J Vasc Surg,2022,7(1):12-29.