|
|
肿胀麻醉在热消融术治疗下肢静脉曲张中的应用现状
|
Abstract:
下肢静脉曲张通常指在各种因素作用下，引起的下肢浅静脉迂曲、扩张，可同时伴下肢酸胀、乏力及沉着感等功能异常症状，晚期可出现脂质硬化、慢性溃疡等病变，是血管外科最常见的一种疾病。目前该疾病仍以手术治疗为主，热消融术是腔内微创手术治疗下肢静脉曲张中的代表，具有创伤小、可控性高、疗效满意等优势，被许多临床指南推荐为首选治疗方式。在热消融手术广泛应用的背景下，如何减少术中疼痛、提高手术效率、减少术后并发症，仍是很多医生面临的难题。肿胀麻醉在热消融术治疗下肢静脉曲张中的使用效果显著，但其成分、使用方式、运用时机等仍存在较大的探索空间。本文就肿胀麻醉在下肢静脉曲张射频消融术中的应用现状进行综述。
Lower extremity varicose veins (LEVV) typically refer to the tortuosity and dilation of superficial veins caused by multiple etiological factors, often accompanied by functional abnormalities such as lower limb soreness, fatigue, and heaviness. Advanced stages may manifest pathological changes including lipodermatosclerosis and chronic ulcers, making it the most prevalent condition in vascular surgery. Surgical intervention remains the mainstay treatment, with thermal ablation emerging as the representative endovenous minimally invasive technique. Recognized for its minimal invasiveness, high controllability, and satisfactory therapeutic outcomes, this modality has been recommended as the primary treatment option by numerous clinical guidelines. However, despite its widespread application, challenges persist in reducing intraoperative pain, enhancing surgical efficiency, and minimizing postoperative complications. Tumescent anesthesia has demonstrated significant efficacy in thermal ablation procedures for LEVV, yet substantial exploration is still required regarding its optimal composition, administration methods, and timing during intervention. This review comprehensively examines current applications of tumescent anesthesia in radiofrequency ablation for lower extremity varicose veins and discusses potential avenues for clinical optimization.
| [1] | 李日成, 潘海邦, 王波, 刘美. 下肢静脉曲张研究热点与发展趋势的可视化分析[J]. 应用激光, 2024, 44(5): 225-234. |
| [2] | 林奕辰, 郭平凡. 超声引导下麻醉肿胀液在下肢曲张静脉泡沫硬化剂注射中的应用[J]. 福建医科大学学报, 2019, 53(5): 352-354. |
| [3] | 杨纯旭, 张玥, 匡英杰, 刘效敏. 静脉腔内热消融术治疗下肢静脉曲张研究进展[J]. 中国医学装备, 2024, 21(8): 176-181. |
| [4] | Liu, Y., et al. (2020) Tumescent Local Anesthesia: A Systematic Review of Outcomes. medRxiv. |
| [5] | 梅家才, 郑月宏. 原发性下肢浅静脉曲张诊治专家共识(2021版)[J]. 血管与腔内血管外科杂志, 2021, 7(7): 762-772. |
| [6] | 黄金刚, 张子涵, 陈超, 胡鸿, 邱世香, 钟立明. 下肢静脉曲张微创治疗的研究进展[J]. 现代医学, 2023, 51(7): 1024-1029. |
| [7] | 郑月宏, 梅家才, 职康康. 下肢浅静脉曲张诊治微循环专家共识[J]. 中华老年多器官疾病杂志, 2020, 19(1): 1-7. |
| [8] | 刘宗芬, 于艺伟, 孙波等. 射频消融术治疗下肢静脉曲张的研究进展[J]. 血管与腔内血管外科杂志, 2021, 7(2): 205-208, 213. |
| [9] | 杨纯旭, 张玥, 匡英杰, 等. 静脉腔内热消融术治疗下肢静脉曲张研究进展[J]. 中国医学装备, 2024, 21(8): 176-181. |
| [10] | 周思聪, 林晶. 腔内射频闭合术治疗下肢静脉曲张患者的临床效果[J]. 医疗装备, 2022, 35(10): 101-103. |
| [11] | Gloviczki, P., Lawrence, P.F., Wasan, S.M., Meissner, M.H., Almeida, J., Brown, K.R., et al. (2023) The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society Clinical Practice Guidelines for the Management of Varicose Veins of the Lower Extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 11, 231-261.e6. https://doi.org/10.1016/j.jvsv.2022.09.004 |
| [12] | 李伟, 李威, 满文玲, 等. 射频消融术在下肢静脉曲张中的运用价值[J]. 中华介入放射学电子杂志, 2021, 9(1): 85-91. |
| [13] | Uttamani, R., Venkataram, A., Venkataram, J. and Mysore, V. (2020) Tumescent Anesthesia for Dermatosurgical Procedures Other than Liposuction. Journal of Cutaneous and Aesthetic Surgery, 13, 275-282. https://doi.org/10.4103/jcas.jcas_192_19 |
| [14] | Nyamekye, I.K. (2018) A Practical Approach to Tumescent Local Anaesthesia in Ambulatory Endovenous Thermal Ablation. Phlebology: The Journal of Venous Disease, 34, 238-245. https://doi.org/10.1177/0268355518800191 |
| [15] | Nandhra, S., Wallace, T., El-Sheikha, J., Leung, C., Carradice, D. and Chetter, I. (2018) A Randomised Clinical Trial of Buffered Tumescent Local Anaesthesia during Endothermal Ablation for Superficial Venous Incompetence. European Journal of Vascular and Endovascular Surgery, 56, 699-708. https://doi.org/10.1016/j.ejvs.2018.05.017 |
| [16] | Vourliotakis, G., Sahsamanis, G., Evagelidis, P. and Aivatidi, C. (2018) Endovascular Laser Treatment of Incompetent Saphenous Veins Using the 1470 Nm Diode Laser and Radial Fiber. Annals of Medicine & Surgery, 25, 12-16. https://doi.org/10.1016/j.amsu.2017.12.002 |
| [17] | 邓晓涛, 王丙龙, 陶遂, 等. 腔内激光与泡沫硬化剂闭合术在轻中度下肢静脉曲张治疗中的应用价值对比[J]. 血管与腔内血管外科杂志, 2022, 8(3): 357-362. |
| [18] | 王云鹏, 姚野, 张博, 等. 射频消融术治疗下肢静脉曲张[J]. 内蒙古医科大学学报, 2019, 41(6): 670-672. |
| [19] | 洪进, 黄海燕, 谢利成, 等. 局部麻醉在下肢浅静脉曲张腔内射频消融术中的临床效果[J]. 血管与腔内血管外科杂志, 2023, 9(9): 1103-1107. |
| [20] | Bitargil, M. and El Kiliç, H. (2020) Comparing Local Tumescent Anesthesia and Spinal Anesthesia Methods during and after Endovenous Radiofrequency Ablation of Great Saphenous Vein. International Angiology 39, 461-466. |
| [21] | 沈培松, 黄庆锦, 王铭伟, 等. 局部肿胀麻醉联合硬膜外麻醉在大隐静脉高位结扎并抽剥术中的临床疗效[J]. 血管与腔内血管外科杂志, 2021, 7(3): 262-266, 270. |
| [22] | Gloviczki, P., Comerota, A.J., Dalsing, M.C., Eklof, B.G., Gillespie, D.L., Gloviczki, M.L., et al. (2011) The Care of Patients with Varicose Veins and Associated Chronic Venous Diseases: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. Journal of Vascular Surgery, 53, 2S-48S. https://doi.org/10.1016/j.jvs.2011.01.079 |
| [23] | Li, Y. and Li, T. (2024) Enhancing Patient Comfort in Varicose Vein Treatment through Combined Lidocaine and Ropivacaine Tumescent Anesthesia. Frontiers in Surgery, 11, Article 1359474. https://doi.org/10.3389/fsurg.2024.1359474 |
| [24] | 董娜, 刘君, 陈修翠, 等. 碳酸氢钠在大隐静脉曲张射频消融术中的应用价值[J]. 血管与腔内血管外科杂志, 2024, 10(6): 734-738. |
| [25] | Vent, A., Surber, C., Graf Johansen, N.T., Figueiredo, V., Schönbächler, G., Imhof, L., et al. (2020) Buffered Lidocaine 1%/Epinephrine 1:100,000 with Sodium Bicarbonate (Sodium Hydrogen Carbonate) in a 3:1 Ratio Is Less Painful than a 9:1 Ratio: A Double-Blind, Randomized, Placebo-Controlled, Crossover Trial. Journal of the American Academy of Dermatology, 83, 159-165. https://doi.org/10.1016/j.jaad.2019.09.088 |
| [26] | 李谈, 张杨, 廖传军, 等. 添加碳酸氢钠配制的肿胀麻醉液在大隐静脉曲张射频消融术中的应用[J]. 中国病案, 2023, 24(7): 109-113. |
| [27] | 江志虹, 阎军, 王世材, 等. 蠕动泵推注肿胀液在下肢静脉曲张病人行大隐静脉射频消融术中的应用[J]. 护理研究, 2023, 37(17): 3167-3170. |
| [28] | Boschert, M. and Puckett, C. (1998) Tumescent Infusion for Liposuction: A Practical Method and Pressure Delivery System. Aesthetic Surgery Journal, 18, 266-268. https://doi.org/10.1016/s1090-820x(98)70055-x |
| [29] | Luo, L., Chen, Z., Hu, L., Ma, C. and Xiao, E. (2019) Tumescence Anesthesia Solution-Assisted Laser Ablation Treatment of Lower Limb Varicose Veins: The Effect of Temperature of the Tumescence Anesthesia Solution on Intraoperative and Postoperative Pain, Clinical Observations, and Comprehensive Nursing Care. Journal of PeriAnesthesia Nursing, 34, 368-375. https://doi.org/10.1016/j.jopan.2018.06.091 |
| [30] | Memetoglu, M.E., Kurtcan, S., Kalkan, A. and Özel, D. (2010) Combination Technique of Tumescent Anesthesia during Endovenous Laser Therapy of Saphenous Vein Insufficiency. Interactive CardioVascular and Thoracic Surgery, 11, 774-778. https://doi.org/10.1510/icvts.2010.240762 |
