简化栓塞策略在盆腔静脉疾病治疗中的应用疗效及安全性分析

Efficacy and safety of a simplified embolization strategy in the treatment of pelvic venous disease

摘要:

背景与目的 盆腔静脉疾病（PeVD）是慢性盆腔痛的重要血管性病因，其中卵巢静脉反流最为常见。卵巢静脉栓塞已被证实具有良好疗效，但在实际应用中，栓塞范围、弹簧圈数量及是否需要联合处理其他盆腔静脉病变等技术细节尚缺乏统一共识。本研究旨在评估采用简化策略的左侧卵巢静脉弹簧圈栓塞联合硬化剂注射治疗PeVD的短中期疗效及安全性。方法 回顾性分析2023年2月—2024年2月收治的55例PeVD女性患者，均经超声、CT静脉造影及静脉造影确诊，并接受左侧卵巢静脉弹簧圈栓塞联合硬化剂治疗。随访1、3、6、12个月，比较术前与术后疼痛视觉模拟评分（VAS）、症状改善情况及并发症发生情况；术后3个月行超声评估卵巢静脉闭塞及盆腔静脉改善情况。结果 所有患者均获得技术成功。术后12个月VAS由术前的7.2±1.2降至2.9±2.8（P<0.01），81.8%患者症状改善，其中50.9%症状完全消失。术后3个月超声显示卵巢静脉均完全闭塞，左侧宫旁静脉直径较术前显著减小［（7.1±1.4）mm vs. （3.4±0.7）mm，P<0.001］。总体并发症发生率为14.5%，以一过性盆腔痛为主，均经对症处理后缓解。结论 采用简化栓塞策略的左侧卵巢静脉弹簧圈栓塞联合硬化剂注射治疗PeVD具有良好的短中期疗效和安全性，可作为以左侧卵巢静脉反流为主患者的有效微创治疗方案。

Abstract:

Background and Aims Pelvic venous disease (PeVD) is an important vascular cause of chronic pelvic pain, with ovarian vein reflux being the most common underlying mechanism. Ovarian vein embolization has been proven effective; however, key technical aspects-including embolization extent, coil number, and the need for concomitant treatment of other pelvic venous abnormalities-remain controversial. This study aimed to evaluate the short- and mid-term efficacy and safety of a simplified strategy using left ovarian vein coil embolization combined with sclerotherapy for the treatment of PeVD.Methods A retrospective analysis was performed on 55 female patients with PeVD treated between February 2023 and February 2024. All patients were diagnosed using ultrasound, CT venography, and venography, and underwent left ovarian vein coil embolization combined with sclerotherapy. Follow-up assessments were conducted at 1, 3, 6, and 12 months post-procedure, including visual analog scale (VAS) scores, symptom improvement, and complications. Doppler ultrasound at 3 months was used to evaluate ovarian vein occlusion and pelvic venous changes.Results Technical success was achieved in all patients. At 12 months, the mean VAS score significantly decreased from 7.2±1.2 preoperatively to 2.9±2.8 (P<0.01). Symptom improvement was observed in 81.8% of patients, with complete symptom resolution in 50.9%. Ultrasound at 3 months confirmed complete ovarian vein occlusion in all cases, and the diameter of the left parauterine vein significantly decreased compared with baseline [(7.1±1.4) mm vs. (3.4±0.7) mm, P<0.001]. The overall complication rate was 14.5%, predominantly transient pelvic pain, which resolved with conservative management.Conclusion A simplified embolization strategy using left ovarian vein coil embolization combined with sclerotherapy is safe and effective for patients with PeVD predominantly caused by left ovarian vein reflux and represents a reliable minimally invasive treatment option.