Noppeney T, Nüllen H
MVZ Gefässmedizin Nürnberg, Nürnberg, Deutschland.
Internist (Berl). 2010 Mar;51(3):344-50. doi: 10.1007/s00108-009-2515-7.
While the treatment of varicose veins has remained unchanged over the past 100 years based on the three principles of compression, sclerotherapy, and classic varicose vein surgery, alternative approaches and advancements in treatment have developed in the last 10 years such as foam sclerotherapy, endovenous laser therapy, and radiofrequency obliteration. In contrast to classic varicose vein surgery, prospective, randomized, comparative studies are available with respect to the modern treatment procedures. They clearly show that endovenous thermal techniques are not inferior to the classic operation regarding the perioperative complication rate. There appears to be a tendency toward considerably fewer perioperative complaints with endovenous laser therapy and in particular with radiofrequency obliteration. Foam sclerotherapy represents a minimally invasive alternative that is markedly cost-effective. Even though the occlusion rate of the root veins after foam sclerotherapy is not as good as after endovenous therapy, the method is initially very effective. Especially in cases of recurrent varicose veins from the saphenofemoral or popliteal junction, foam sclerotherapy should be considered as the ideal method. All procedures significantly improve the patients' quality of life and the symptom complaints related to varicose veins. They are not in competition, but rather partially complement each other so that a combination of several approaches is quite judicious.
尽管在过去100年里，基于压迫、硬化疗法和经典静脉曲张手术这三个原则，静脉曲张的治疗方法一直没有改变，但在过去10年里，出现了一些替代方法和治疗进展，如泡沫硬化疗法、静脉内激光治疗和射频消融术。与经典静脉曲张手术不同，关于现代治疗方法有前瞻性、随机、对照研究。这些研究清楚地表明，就围手术期并发症发生率而言，静脉内热技术并不逊色于经典手术。静脉内激光治疗，尤其是射频消融术，似乎有明显减少围手术期不适的趋势。泡沫硬化疗法是一种微创替代方法，具有显著的成本效益。尽管泡沫硬化疗法后根部静脉的闭塞率不如静脉内治疗后好，但该方法起初非常有效。特别是在大隐静脉-股静脉或腘静脉交界处复发性静脉曲张的病例中，泡沫硬化疗法应被视为理想方法。所有治疗方法都能显著改善患者的生活质量以及与静脉曲张相关的症状。它们并非相互竞争，而是部分相互补充，因此几种方法联合使用是非常明智的。
