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[精索静脉曲张、盆腔静脉曲张与盆腔淤血综合征:介入放射学在诊断与治疗中的应用]

[Varicoceles, pelvic varices and pelvic congestion syndrome: Interventional radiology in diagnosis and treatment].

作者信息

Paisant-Thouveny Francine, Le Pennec Vincent, Loffroy Romaric

机构信息

CHU Angers, service de radiologie C, pôle SIS, 49933 Angers cedex, France.

CHU Côte de Nacre, CHU Caen, service de radiologie diagnostique et thérapeutique, pôle d'imagerie médicale et explorations fonctionnelles, 14000 Caen, France.

出版信息

Presse Med. 2019 Apr;48(4):419-434. doi: 10.1016/j.lpm.2019.03.008. Epub 2019 May 14.

Abstract

Genital venous insufficiency in men is usually of constitutional origin due to valvular incontinence. Genital venous insufficiency in female is more often generated by major, lasting, and possibly repeated pregnancy-related hyperpressure phenomena. Genital venous insufficiency in men is usually expressed by visible and recognizable peritesticular varicocele. Of simple anatomic structure, it is easily accessible to endovascular treatment by embolization, which is the first-line therapy nowadays. Genital venous insufficiency in women results in a pelvic predominant varicosis, which should be evoked in case of chronic pelvic pain or atypical venous afferents to the lower limbs. Precise and guided interrogation and clinical examination allow the attending physician to be the first actor in the detection of symptomatic pelvis venous insufficiency in men and women. A chronic pelvic pain in female should evoke a pelvic congestion syndrome, symptomatic translation of pelvic varicosis, especially if it increases at the end of the day, at the effort, in pre-menstrual period. Treatment with endovascular embolization is the only therapeutic option for female pelvic venous insufficiency, of complex architecture and deep anatomical situation. The interventional radiologist offers a complete, minimally invasive and efficient treatment with limited hospital costs and perioperative constraints.

摘要

男性生殖器静脉功能不全通常源于体质因素导致的瓣膜失禁。女性生殖器静脉功能不全则更多是由重大、持久且可能反复出现的与妊娠相关的高压现象引起。男性生殖器静脉功能不全通常表现为可见且可识别的睾丸周围静脉曲张。其解剖结构简单,通过栓塞进行血管内治疗很容易实现,栓塞是目前的一线治疗方法。女性生殖器静脉功能不全会导致以盆腔为主的静脉曲张,在出现慢性盆腔疼痛或下肢非典型静脉传入时应考虑到这种情况。精确且有针对性的问诊和临床检查使主治医生能够成为检测男性和女性有症状的盆腔静脉功能不全的首要行动者。女性的慢性盆腔疼痛应考虑盆腔充血综合征,这是盆腔静脉曲张的症状表现,尤其是在一天结束时、用力时、经前期疼痛加剧的情况下。血管内栓塞治疗是女性盆腔静脉功能不全唯一的治疗选择,因为其结构复杂且解剖位置较深。介入放射科医生提供了一种完整、微创且有效的治疗方法,同时住院费用有限且围手术期限制较少。

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