Department of Faculty Surgery No. 1, Medical Faculty, Pirogov Russian National Research Medical University, Moscow, Russia.
Curr Med Res Opin. 2019 Jan;35(1):27-31. doi: 10.1080/03007995.2018.1498781. Epub 2018 Jul 25.
The aim of study was to investigate the opportunities of local phlebectomy in the elimination of isolated pelvic-perineal reflux (PPR), as well as to determine the feasibility of endovascular embolization of the tributaries of internal iliac veins in PPR. Clinical trial no. NCT01598051. The work is based on the results of examination and treatment of 43 female patients with varicose veins of the pelvis, perineum, and lower extremities. Patients had no signs of pelvic congestion syndrome (PCS). All patients underwent duplex ultrasound scanning (DUS) and ovariography with pelvic phlebography (OPP). For the elimination of PPR, local phlebectomy was performed in the major labia and perineal area, with maximal possible mobilization of the vessel within the operative wound (33 patients). In 10 patients with isolated varicose transformation of the superficial veins on the posterior thigh, mini-phlebectomy was performed using the Varady phlebectomy extractors. The varicose syndrome of the external genitalia, perineum, and posterior thigh was successfully treated in 100% of patients. Findings suggest that thorough mobilization and excision of the veins of the pudendal labia, perineum, and subcutaneous veins of the thigh is a reliable method for eliminating the pathological reflux from the intrapelvic veins to the superficial veins of the perineum and lower extremities. No recurrences of vulvar, perineal varices or dilation of the veins of the lower extremities were observed in 100% of patients over the 3-year follow-up period. Local phlebectomy is an effective technique for eliminating the isolated PPR in patients with varicose transformation of intrapelvic, vulvar, or perineal veins. Endovascular embolization of the tributaries of the internal iliac veins is not an essential component in the treatment of PPR. The present study has a limitation due to the absence of patients with PCS. The effectiveness of phlebectomy in the treatment of isolated PPR was studied.
研究目的在于探讨局部静脉切除术在消除孤立性盆腔-会阴反流（PPR）中的应用机会，并确定 PPR 内髂静脉属支腔内栓塞的可行性。临床试验编号 NCT01598051。本工作基于对 43 例盆腔、会阴和下肢静脉曲张女性患者的检查和治疗结果。患者均无盆腔淤血综合征（PCS）的征象。所有患者均行双功能超声检查（DUS）和卵巢造影盆腔静脉造影术（OPP）。为消除 PPR，在大阴唇和会阴区域进行局部静脉切除术，在手术切口内最大限度地移动血管（33 例）。在 10 例大腿后侧浅静脉孤立性静脉曲张患者中，采用 Varady 静脉切除术抽取器行小静脉切除术。100%的患者外阴、会阴和大腿后侧静脉曲张综合征得到成功治疗。研究结果表明，彻底移动和切除会阴大阴唇、会阴和大腿皮下静脉是消除从盆腔内静脉到会阴和下肢浅静脉的病理性反流的可靠方法。在 3 年的随访期间，100%的患者均未出现外阴、会阴静脉曲张或下肢静脉扩张的复发。局部静脉切除术是消除盆腔内、外阴或会阴静脉曲张患者孤立性 PPR 的有效技术。内髂静脉属支腔内栓塞不是 PPR 治疗的必要组成部分。由于缺乏 PCS 患者，本研究存在一定局限性。本研究旨在探讨静脉切除术治疗孤立性 PPR 的效果。
