Pieri Stefano, Agresti Paolo, Morucci Morucci, de' Medici Lorenzo
Servizio di Radiologia Vascolare ed Interventistica, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy.
Radiol Med. 2003 Jan-Feb;105(1-2):76-82.
Pelvic congestion syndrome and chronic pelvic pain are enigmatic clinical conditions that may have considerable impact on the social and relational life of women. Patients usually complain of lower abdominal pain that has lasted for more than six months, is intermittent or continuous, and may become worse during menses or after a hard day's work. Sometimes the pain is accompanied by dyspareunia, urinary urgency or constipation. The traditional treatment of pelvic congestion syndrome has included both medical (analgesics, hormones) and surgical approaches (hysterectomy, ovarian vein ligation). Recently, percutaneous transcatheter embolization has also been proposed. We report our experience with the percutaneous management of pelvic congestion syndrome, using the transbrachial approach and sclerosis alone.
Between 1996 and 2001, 33 women underwent percutaneous treatment for pelvic congestion syndrome at our department. All the women had chronic pelvic pain which was continuous in 69%; 20 patients had dyspareunia, whereas 8 had urinary urgency; 72% took analgesics on a regular basis. All the patients underwent percutaneous treatment of pelvic congestion syndrome on a outpatient basis in a radiological suite, after receiving local anaesthesia. Sclerosis was performed with 3% sodium tetradecyl sulfate. Follow-up consisted of a questionnaire at one month and gynaecological and ultrasound examinations at 6/12 months.
The pre-procedural ultrasound examination had revealed a mean diameter of 4.5 mm for the right ovarian vein and of 6.3 mm for the left. We found one pelvic congestion syndrome on the right, 11 on the left and 21 bilaterally. At the one-month follow-up, chronic pelvic pain was present in 13 patients (39%); the pain was continuous in three and intermittent in ten. At the follow-up after 6/12 months the symptoms were unchanged. Ultrasound revealed a reduction in periovarian varicosities, recording a mean diameter of 3.19 mm on the right and 4.5 mm on the left. Symptoms persisted in women with pelvic varicosities measuring over 5 mm at ultrasound.
Pelvic congestion syndrome and chronic pelvic pain that do not respond to medical therapy can be resolved by percutaneous management. Less expensive than surgery, this therapeutic option is safe, effective, minimally invasive and capable of restoring patients to normal function. We propose the transbrachial approach as the first-choice treatment for bilateral pelvic congestion syndrome.
盆腔淤血综合征和慢性盆腔疼痛是难以捉摸的临床病症，可能对女性的社交和人际关系生活产生重大影响。患者通常主诉下腹部疼痛持续超过六个月，疼痛为间歇性或持续性，在月经期间或劳累一天后可能加重。有时疼痛伴有性交困难、尿急或便秘。盆腔淤血综合征的传统治疗方法包括药物治疗（镇痛药、激素）和手术治疗（子宫切除术、卵巢静脉结扎术）。最近，经皮经导管栓塞术也被提出。我们报告了我们使用经肱动脉途径单独进行硬化治疗盆腔淤血综合征的经验。
1996年至2001年期间，我们科室有33名女性接受了盆腔淤血综合征的经皮治疗。所有女性均患有慢性盆腔疼痛，其中69%为持续性疼痛；20例患者有性交困难，8例有尿急；72%的患者定期服用镇痛药。所有患者在接受局部麻醉后，于放射科门诊接受盆腔淤血综合征的经皮治疗。使用3%的十四烷基硫酸钠进行硬化治疗。随访包括在一个月时进行问卷调查，在6/12个月时进行妇科和超声检查。
术前超声检查显示右侧卵巢静脉平均直径为4.5毫米，左侧为6.3毫米。我们发现右侧有1例盆腔淤血综合征，左侧有11例，双侧有21例。在一个月的随访中，13例患者（39%）仍有慢性盆腔疼痛；其中3例疼痛为持续性，10例为间歇性。在6/12个月后的随访中，症状未改变。超声显示卵巢周围静脉曲张有所减少，右侧平均直径为3.19毫米，左侧为4.5毫米。超声检查发现盆腔静脉曲张直径超过5毫米的女性症状持续存在。
对药物治疗无反应的盆腔淤血综合征和慢性盆腔疼痛可通过经皮治疗得到解决。这种治疗选择比手术便宜，安全、有效、微创，能够使患者恢复正常功能。我们建议将经肱动脉途径作为双侧盆腔淤血综合征的首选治疗方法。
