- Особенности хирургического лечения прогрессирующей варикозной болезни нижних конечностей у беременных
Особенности хирургического лечения прогрессирующей варикозной болезни нижних конечностей у беременных
HEALTH OF WOMAN. 2016.2(108):68–74; doi 10.15574/HW.2016.108.68
Особенности хирургического лечения прогрессирующей варикозной болезни нижних конечностей у беременных
Антонюк-Кисель В. Н., Еникеева В. Н., Личнер С. И., Липный В. М., Дрозд В. В.
КУ «Областной перинатальный центр» Ровенского областного совета
Цель исследования: разработка комплекса мероприятий для безопасного хирургического вмешательства с целью предотвращения прогрессирования варикозной болезни нижних конечностей у беременных с минимальным влиянием на течение беременности, развитие плода и корректного вынашивания беременности.
Материалы и методы. Хирургическое лечение проведено 76 пациенткам с прогрессирующей варикозной болезнью нижних конечностей. Выполнено 107 оперативных вмешательств, преимущественно во II триместре (76,3%) и в III триместре (23,7%) беременности в плановом порядке. Использовали для обезболивания у 90,8% беременных местную анестезию: ее разновидность – тумесцентную анестезию по Дж. Кляйну. Для предотвращения развития синдрома нижней полой вены у беременных во время оперативного вмешательства укладывали беременную на операционный стол на левый бок под углом 30°.
Результаты. Разработанный комплекс мероприятий позволил получить у 100% беременных (по их субъективной оценке) положительный результат хирургического лечения прогрессирующей варикозной болезни нижних конечностей и уберечь их от осложнений во время беременности, родов и в послеродовой период. Оценку результатов хирургического лечения проводили на 1-й и на 2-й день и через 2 нед после операции.
Заключение. Тесное сотрудничество врача-акушера и сосудистого хирурга в специализированном акушерском учреждении является определяющим в выборе тактики лечения прогрессирующей варикозной болезни нижних конечностей у беременных. Знание особенностей течения беременности, изменений в анатомии и особенности гемодинамики в венозной системе нижних конечностей во время беременности, выполнение малотравматичного хирургического вмешательства в оптимальные сроки беременности высококвалифицированным флебологом позволяет получить по субъективной оценке беременных 100% положительный результат.
Ключевые слова: прогрессирующая варикозная болезнь нижних конечностей у беременных, тумесцентная анестезия, синдром нижней полой вены, хирургическое лечение варикозного расширения подкожных вен во время беременности.
Литература:
1. Alekhin DI, Nikolenko LA Perseva EB Goloshapova JA. 2008. The level of progesterone in pregnancy as a factor in the development of varicose veins disease. Problems of reproduction 6: 87-90.
2. Artimuk NB. 2007. Varicose veins disease of the pelvic organs. Russian herald of obstetrician-gynecologist 6: 74-77.
3. Benyuk VO, Medvid VI, Koval SD, Kurochka VV. 2011. Complex therapy of gestational varicose disease. 6 Women's Health (62): 12-14.
4. Benyuk VO, Medvid VI, Nykonyuk TR, Koval SD. 2013. Features of the postpartum period with gestational varicose veins disease. Women health 4 (80): 39-42.
5. Benyuk VO, Medvid VI, Nykonyuk TR, Koval SD. 2010. Preventing complications of varicose disease in pregnant women. Women health 8 (54): 84-87.
6. Bogachev VY. 2006. Varicose disease during and after pregnancy. Gynecology 8 (5): 24-28.
7. Bogachev VD. 2002. Hormone-induced phlebopathy. The new problem of modern phlebology. Angiology and Vascular Surgery 3: 50-57.
8. Budanov PV, Avlanova PA. 2009. Modern possibilities prevention and treatment of venous insufficiency during pregnancy. Gynecology 6: 10-14.
9. Vasylyuk MD, Shevchuk MG. 1992. Varicose disease of the lower limbs in women. K Health: 184.
10. Ventskіvska IB, Zhabіtska LA Ventskіvskyy KO. 2008. Vinitan Forte with varicose veins disease in pregnant women. Medical aspects of women's health 2 (11): 10-12.
11. Gerasimova TV, Gonchuk EN. 2012. Chronic venous insufficiency — medical problem or a disease of civilization. Women Health 2 (68): 23-25.
12. Gurtovoiy BD, Geraschenkova ZP. 1977. Varicose veins in pregnancy. Obstetrics and Gynecology 5: 61-63.
13. Zaloga KN. 1965. Varicose veins disease during pregnancy and its treatment. Surgery 9: 38-41.
14. Zilber AP, Schiffman EM. 1997. Obstetrics eyes of anesthesiologist. Petrozavodsk: 396.
15. Zolotukhin IA. 2005. Features of the treatment and prevention of chronic venous insufficiency of the lower limbs and its complications in pregnancy. Breast cancer. 13; 17: 1113-1116.
16. Zolotukhin IA. 2006. Risk factors for chronic venous insufficiency of the lower limbs and the possibility of medical treatment. Surgery. Consilium Medicum, 1: 40-43.
17. Kaydorin AG. 1997. Ways of optimization of diagnostic surgical treatment non-complication of varicose disease. Author. diss. Dr. med. Sciences. Novosibirsk 48.
18. Kayukova TM. 2006. Chronic venous insufficiency of the lower limbs in pregnancy: a modern approach to the problem. Woman doctor 5: 15-16.
19. Kuzmenko OB, Mihaylychenko VO et al. 2015. Innovative methods of surgical treatment of varicose veins disease of the lower limbs: discussion questions. Hіrurgіya Ukraine 1 (53): 112-119.
20. Kulakov VI, Chernaya VV, Baluda VP. 1982. Acute thrombosis of the lower limbs in obstetrics. M Medicine: 208.
21. Kulakov VI, Murashko AV, Fayzullin et al 2002. Genetic predisposition to varicose veins disease in pregnancy:. Possible confirmation? Pregnancy problems 7: 31-35.
22. Kolesnikova RS. 1977. Treatment of veins diseases in women (due to pregnancy and childbirth). M Medicine: 183.
23. Leizerovich G. 1999. Surgical and gynecological diseases in pregnant women. Obstetrics: UCLA guide. M. G 15: 318-347.
24. Lesnojy II, Klimchuk LV, Lesnaja IN. 2010 November. Features of perception of pain in women. Medical aspects of women's health 8 (37): 68-71.
25. Leush SS Terentyuk VG Karpuk PI. 2002. The syndrome of the inferior vena cava in pregnant women. Ukrainian Medical Journal 6/32 X1 / X11: 56-59.
26. Lyzin MA. 1985. Some of the pathogenesis and prevention of varicose subcutaneous veins of the lower limbs, arising during the current pregnancy. Author. diss. cand. med. sciences. K: 24.
27. Logutova LS Petruhin VA et al. Angioprotectors 2007. Efficiency in the treatment of pregnant women with placental insufficiency. Russian herald of obstetrician 7; 2: 42-48.
28. Mamamtavrashvili DG. 1967. Controversial issues of surgical treatment of occlusive diseases of the lower limbs 9: 93-95.
29. Medvid VI, Benyuk VA Koval SD. 2010. Venous complications in pregnancy. Medical aspects of women's health 7 (35): 29-33.
30. Medvid VI, Danilkiv OO. 2007. Topical treatment of varicose disease and chronic venous insufficiency in pregnant women. Reproductive women health 5: 62-64.
31. Murashko AV, Kumykova SX. 2007. Chronic venous insufficiency and pregnancy. Gynecology 8; 1: 98-102.
32. Murashko AV. 2005. The veins disease and pregnancy. Gynecology 11; 5: 23-28.
33. Murashko AV. 2002. Drug therapy of chronic venous insufficiency during pregnancy. Obstetrics and Gynecology 6: 25-28.
34. Murashko AV. 2000. The etiology and pathogenesis of chronic venous insufficiency during pregnancy. Problems of pregnancy 2: 16-21.
35. Mozes VG. 2006. Varicose veins of small pelvis in women in the main age-biological periods of life. Author. diss. candidate. med. sciences. Tomsk: 21.
36. Nikolaenkova VA. 1970. On the issue of pathogenesis of varicose vein disease of the lower extremities. Materials of Scientific Conference, dedicated to the 50th of Institute Works of the Smolensk Medical Institute. 29: 161-163.
37. Novikov KV. 2001. Surgical treatment of varicose veins disease of the lower extremities in pregnant women. Outpatient Surgery 2 (2): 37-38.
38. Novikov KV, Vorobiev VV, Abashin VG. 2009 November. Surgical treatment of varicose veins in pregnant women. Materials III Congress of Russian surgeons outpatient. Ambulatory hіrurgіya 3-4 (35-36): 40-41.
39. Padalko AA, Peszher AA, Mehedko VV, Romaniuk EU. 2014. Peculiarities of cardiopulmonary resuscitation in pregnancy. Women's Health 2 (88): 66-69.
40. Petrov VV. 2011. Segmental flebektomiya in pregnant women with advanced varicose veins disease of the lower extremities. Author. diss. cand. med. sciences. St. Petersburg.
41. Persianinov LS, Demidov VN. 1987. Features of the circulatory system in pregnant and postpartum women. M Medicine: 288.
42. Romanenko TG. 2011. Chronic venous insufficiency during pregnancy. Lioton 1000 Gel: Experience therapeutic and prophylactic applications. 9 Women's Health (65): 83-86.
43. Sabel'nikov VV, Shulepova EK. 2001. Varicose veins disease of the lower extremities. The modern view on the problem. Medicine World 3-4: 3-5.
44. Sumskaia GF, Liapina EN. 2004. Experience with the drug Cyclo 3 Fort in pregnant women with varicose veins disease. Reproductive health of women 3 (19): 17-18.
45. Serov VN, Zharov EV. 2014. Chronic venous insufficiency. Family Medicine 6 (56): 14-20.
46. Turaev PI, Bobrov OE, Mendel NA, Muz NI. 2002. Chronic venous insufficiency, varicose and posttromboflebotyk disease of the lower extremities. K Phoenix: 108.
47. Tsyboeva GI. 2005. The choice of method of treatment of varicose disease and its complications in pregnant and postpartum women. Author. diss. candidate of medical sciences. Dushanbe: 108.
48. Sharav Tserensabuu. 2004. Varicose veins of lower extremity disease during pregnancy (a condition of fetoplacental system). Author. Dis. cand. medical sciences. Irkutsk.
49. Shevchenko YL. 2005. Fundamentals of Clinical Phlebology. Edited by YL Shevchenko, YM Stojko, MI Lytkina. M, OJSC "Publisher " Medicine": 312.
50. Shekoyan AO Bogachev VY. 2010. Venous pain: pathophysiology and treatment guidelines. Flebolifologiya 3.6: 2-5.
51. Shechtman MM. 2003. Manual for extragenital pathology in pregnant women. M, Triad-X: 816.
52. Shvalb PG. 2005. Questions of Angiology, vascular and operative surgery. Ryazan 3.
53. Arnold JO, Klement W. 1991. Pain evoked by polymodal stimulation of hand veins humans.J.Physiol. 440–467.
54. Danilenko-Dixon DR, Heit JA, Silverstein MD. 2001, Jan. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum a population based case – control stady. Am,J.obstet.Gynecol. 184;2:104–110.
55. Delaney AG. 1983. Anestesia in the pregnant woman. Clin, obsstet.Gynecology: 246–248.
56. Charles P, Gibbs MO. 2008. Анестезия у беременных с неакушерской патологией. Медицина неотложных состояний 4(17):21–23.
57. Curtis A. 1960. The surgery of varicose veins in pregnancy fnd its resulths. Proc.Roy.Soc.Med. 53:840–841.
58. Sodhi MS, Dodd H. 1967. Venous anatomy of the sapheno-femoral area Brit.J.Surg. 54.15.
59. Skudder PAJr, Farrington DR et al. 1990. Venosis disfunction of late pregnancy persists after delivery. J. Cardiovasc. Surg.(Torino). 31;6:748–752.
60. Muller R. 1996. Mise fu point sur la phlebectomie ambulatoire selon muller. Phlebologie 49:335–344.
61. Lenkovic M, Cabrign L, Giuber F et al. 2009. Effecti of progesterone and pregnancy on the development of varicose veins. Acta Dermatovenerol Crout. 17;4:263–267.
62. Krasinski Z, Sajdak S, Staniszewski R et al. 2006. Pregnancy as a risk factor in development of varicose veins in women. Ginekol Pol. 77(6):441–449.
63. Klen JA. 1990. Tumescent technigue for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J.Dermatol.Suegr.Oncol. 16.-h:248-263.
64. Ramelet AA, Kern P, Perrin M. 2003. Les varices et telangiectasies Masson.Paris.
65. Rutherford RB, Padberg FTJr, Comerota J, Kistner RL, Meis-sner MH, Moneta GL. 2000. Venous severitu scoring an adjunct to venous outcome assessment. J. Vasc. Surg. 31:1307–1312. http://dx.doi.org/10.1067/mva.2000.107094; PMid:10842165