Griton P, Cloarec M
Hôpital Tenon-Paris-Policlinique.
Phlebologie. 1992 Jan-Mar;45(1):21-30; discussion 30-1.
In 1960, the first International Conference of Phlebology, organised at Chambéry by Jean Marmasse under the egis of R. Tournay included only three subjects in its programme, one of which was: "venous pain". What is the status of venous pain thirty years on? Can we compare our current concepts with work from past years? Have we advanced in knowledge and in its clinical and therapeutic applications? All these questions are even more worthy of consideration bearing in mind world-wide increased interest in Phlebology and its even richer future. The Chambéry Conference established a clear pattern with: two basic reports: "pain due to essential varicose veins and to trophic disorders" (C. Huriez, F. Desmons, M. Thoreux) and "pain in phlebitis" (R. Fontaine); three analytical and differential reports "pain due to interlinked arterial and venous disorders" (F. Piulachs), "pain in the lower limbs due to interlinked gynecological and venous disorders" (A. Bret, R. Legros) and "pain due to the association of osteoarticular and rheumatic disorders or of neuralgia in venous disease patients" (J. Forestier); and nine other studies, the following being worthy of particular attention: a very interesting report by R. Tournay: "Pain in venous disorders of the lower limbs related to their treatment"; and two papers: "pain of "cellulite" type and the metameric disposition of the lower limbs in relation to functional disorders of the ovary" (S. Bourgeois), and "exercise pain and rest pain in varicose vein sufferers" (J. Marmasse); three German reports (F. Jaeger, F. Maid-Fischer and D. Gross) on the pathogenesis and mechanisms of venous pain; and the report of M. Comel "epiesthesia and histoangeological correlations". Since that time, venous pain has no longer figured in the same format on the programme of any international conference, nor at meetings of the French Society of Phlebology. Progress has thus occurred insidiously... Mention may be made of the following with regard to essential varicose veins: some progress in knowledge of cramps, phlebalgia and venous paresthesiae; attribution to venous syndromes of "restless legs", which have been such a source of intrigue for the past hundred years, and interest in inflammatory pain of the superficial venous system and of subcutaneous cellular tissue in relation with venous insufficiency, as well as ulcer pain. However, it is in the area of acute deep venous thrombosis that everything has been disrupted. Firstly, with the established certainty that the clinical picture leads to errors in more than 50 p. cent of cases, both by excess and default.(ABSTRACT TRUNCATED AT 400 WORDS)
1960年,让·马尔马斯在R. 图尔奈的支持下于尚贝里组织召开了第一届国际静脉学会议,其会议议程仅包含三个主题,其中之一是:“静脉疼痛”。三十年后,静脉疼痛的状况如何?我们能否将当前的概念与过去几年的研究成果进行比较?在知识及其临床和治疗应用方面我们是否取得了进展?鉴于全球对静脉学的兴趣日益浓厚以及其更加光明的未来,所有这些问题都更值得思考。尚贝里会议确立了一个明确的模式:两篇基础报告:“原发性静脉曲张和营养障碍所致疼痛”(C. 于里耶、F. 德蒙、M. 托勒克斯)以及“静脉炎疼痛”(R. 方丹);三篇分析性和鉴别性报告:“动静脉联合病变所致疼痛”(F. 皮乌拉奇)、“妇科与静脉联合病变所致下肢疼痛”(A. 布雷、R. 勒格罗斯)以及“骨关节炎和风湿性疾病或神经痛合并静脉疾病患者的疼痛”(J. 福雷斯蒂耶);还有九项其他研究,以下几项尤其值得关注:R. 图尔奈的一份非常有趣的报告:“下肢静脉疾病治疗相关疼痛”;两篇论文:“‘蜂窝织炎’型疼痛与下肢节段性分布与卵巢功能障碍的关系”(S. 布尔乔亚)以及“静脉曲张患者的运动性疼痛和静息性疼痛”(J. 马尔马斯);三篇关于静脉疼痛发病机制的德国报告(F. 耶格尔、F. 迈德 - 菲舍尔和D. 格罗斯);以及M. 科梅尔的报告“体表感觉与组织血管学相关性”。自那时起,静脉疼痛在任何国际会议或法国静脉学协会会议的议程中都不再以相同的形式出现。因此,进展是悄然发生的……关于原发性静脉曲张,可以提及以下几点:在痉挛、静脉痛和静脉感觉异常的认识上取得了一些进展;将“不宁腿”归因于静脉综合征,在过去的一百年里,“不宁腿”一直是一个充满谜团的问题,并且人们对与静脉功能不全相关的浅静脉系统和皮下蜂窝组织的炎性疼痛以及溃疡疼痛产生了兴趣。然而,在急性深静脉血栓形成领域,一切都被打乱了。首先,已经确定的是,临床表现导致超过50%的病例出现误诊,既有过度诊断也有漏诊。(摘要截选至400字)