Le Pivert P
Phlebologie. 1987 Jan-Mar;40(1):123-48.
The idea of applying cryosurgery to the treatment of lower extremities varicose veins originated in 1978 from three developments: The increasing abundance of experimental and clinical observations of the vascular effect of low temperatures. The development of a more suitable, flexible instrumentation, in collaboration with the Atomic Energy Commissary. The intrinsic advantages of cryosurgery, a painless and less aggressive method, which may be applied to fragile or elderly patients, without general anesthesia. In a first phase (1979-1981) fifty, fragile, elderly or obese patients were treated. All presented a long saphenous reflux. The method demonstrates its feasibility and validity. Two obstacles limit a broader application to the ambulatory treatment of surgical varicose veins: The absence of a strict per-operative control of the ice ball forme at the tip of the cooling device. The conditions of surgery, painful for the patient and un for the physician, because of a bulky, rigid or flexible, instrumentation, which is not very adapted to venous catheterization and does not permit treatment above the knee fold. A second phase of clinical applications started in 1982. Vascular cryoprobes were developed. Because of a better adaptation, they permit the catheterization of most saphenous trunks, in their entirety, and also the control of tissues freezing by measuring the low frequency bioelectric impedance. This study describes: The biological and experimental bases on which rest the venous applications. Cryosurgical instrumentation that we have created and developed. An endoluminal controlled cryosurgical technique of the saphenous trunks. This technique was applied since 1982 to three hundred patients suffering from reflux with ostial incontinence. The results are analyzed in view of clinical and histological findings. The correlation between the absence of venous repermeation and the elevation of per-operative low frequency impedance values, and a follow-up beyond five years for the first patients seem sufficient to justify the present publication, the presentation of this material and to co-ordinate the start of a multicentric study.
将冷冻手术应用于下肢静脉曲张治疗的想法始于1978年，源于以下三个方面的发展：对低温血管效应的实验和临床观察日益丰富；与原子能委员会合作开发出更合适、灵活的器械；冷冻手术本身的优势，即一种无痛且侵袭性较小的方法，可应用于体弱或老年患者，无需全身麻醉。在第一阶段（1979 - 1981年），对50名体弱、老年或肥胖患者进行了治疗。所有患者均存在大隐静脉反流。该方法证明了其可行性和有效性。有两个障碍限制了其在门诊手术治疗静脉曲张方面的更广泛应用：在冷却装置尖端形成冰球时缺乏严格的术中控制；手术条件对患者来说痛苦，对医生来说也不方便，因为器械体积大、刚性或柔性，不太适合静脉插管，且不允许在膝褶以上进行治疗。临床应用的第二阶段始于1982年。开发了血管冷冻探头。由于适应性更好，它们能够完整地对大多数大隐静脉主干进行插管，还能通过测量低频生物电阻抗来控制组织冷冻。本研究描述了：静脉应用所依据的生物学和实验基础；我们创建和开发的冷冻手术器械；大隐静脉主干的腔内可控冷冻手术技术。自1982年以来，该技术已应用于300名患有反流伴开口失禁的患者。根据临床和组织学结果对结果进行了分析。首次患者超过五年的随访以及静脉再通缺失与术中低频阻抗值升高之间的相关性似乎足以证明本出版物的合理性、本材料的展示以及协调多中心研究的启动。
