靜脈血管窄化的議題小結論

感謝Maggie和曉昌的大力幫忙給予資訊上的協助

以下針對靜脈血管窄化的議題稍做一小結論:

1. 首先檢查你靜脈是否狹窄及程度如何？

哪兒可以檢查?:

a: 台北榮總神經醫學中心 找胡漢華教授北榮研發了一套以彩色超音波作頸部靜脈檢查方法，開始找尋與靜脈回流障礙有關之疾病ex:MS,腦中風等。
b: 台北馬偕醫院目前有套先進的「靜脈攝影」(附註)
c: 美國紐約州水牛城大學 找 澤瓦迪諾醫生(Dr. Robert Zivadinov) [能做頸部以及胸腔靜脈檢查]
d: 美國紐約州水牛城全科醫院神經影像分析中心 找 桑伯尼醫生(Dr. Paulo Zamboni) [能做頸部以及胸腔靜脈檢查]

2. 若確定有狹窄--> 要如何處理?
现在的手术方法主要是二种，氣囊(ballon)和支架。
a. 氣囊非常安全，但是再復發相對比较高，就是擴張的血管再度狭窄。
b. 支架不容易出现重新狭窄，但是会有一些风险，比如脱 落，等等。
因为现在的支架都是用于動脈，放在静脈的效果不是太好。以后可能需要设计出專門的静脈支架。

在台灣行之有年的療法是「氣球擴張術」(ballon)
c. 這方面的手術屬於-->「胸腔暨血管外科」, 所以確認之後請找相關的胸腔暨血管外科醫師討論進一步的手術

d. 目前已有MS病人遠至波蘭手術, 請找Dr. Marion Simka,手術費用約USD 10,000

(台灣的醫生技術應該不輸波蘭吧?有沒有台灣醫生願意造福和拯救全世界的MS病患呢?畢竟手術成功率高的話, 全世界將會有250萬名MS病人等待著...或許, 這也是開創台灣醫療的龐大商機....因為連北美洲的病人都遠付歐洲做此一治療了....)

統計現況:
他 们检查发现95%的MS病人有静脉狭窄（支持意大利医生理论），他们手术了90个病人，主要用气囊治疗（63%），支架只是必要时候使用（21%），气 囊+支架治疗（13%）。
治疗结果：大部分病人反映症状改善。总的来看，瘫痪程度轻的患者恢复比较明显。如果没有改善或者复发，通常意外静脉再次 出现狭窄。


經驗案例分享:
除了之前加拿大女生Wendy的例子(也至波蘭...) 還有其他二兄弟手術後的报道，马上感觉MS有好转。手术过程似乎很简单，只花了25分钟，麻药都不需要。請見下文:
Ottawa man sees improvements after surgery to treat MS

An Ottawa man who has multiple sclerosis is experiencing immediate improvements after undergoing vascular surgery in Poland to help treat the disease.
Evan Thornton and his brother Duncan both have MS, the most common neurological disease among young Canadians.
The pair were inspired by a new approach to treat multiple sclerosis and travelled to Poland last week to undergo what's still considered experimental surgery.
"Nobody's saying that you go back to the way you were before you had MS. But the big thing for any MS patient is to stop the progression and I think that's what people are trying to get out of this surgery," said Thornton.
The surgery lasted about 25 minutes, opening up a vein in Thornton's neck. It was done without anesthetic.
He is now on blood thinning medication to ensure blood clots don't develop near the stent that's keeping his jugular vein open.
Improved walking, better circulation
Thornton saw improvements immediately. He can already walk better, and he has improved circulation.
"I've got warm feet, warm hands. That's been a big difference. That's what we noticed right from the beginning. Most people with MS, your extremities are ice cold in the morning," Thornton told CTV Ottawa.
Before the surgery, Thornton was taking one of five disease modifying therapies currently available to help slow down the disease. The treatment involved giving himself a needle every day.
Although he believes the drugs were helping him, the disease was still progressing -- affecting his ability to walk and type.
When he heard about a new approach to MS developed by Dr. Paolo Zamboni in Italy, Thornton jumped at the chance to learn more.
Zamboni's research suggests some of the symptoms of MS may be caused by blocked veins in the neck, which he believes leads to a higher density of iron deposits on the brain.
More research needed
Still, there is much to learn about the procedure and the lasting affects on patients who have MS.
Although patients who've undergone the surgery have experienced drastic improvements, doctors are unsure how long those improvements will last.
"We don't know what will happen after five or 10 years, so we cannot say for sure that it might be a treatment in the long-term," said Dr. Marion Simka, who performed the surgery on Thornton and his brother.
The procedure is not yet performed in Canada, where medical authorities are still studying Zamboni's research.
However, MS patients who want to have the surgery can travel to other countries, such as Poland, to pay for the procedure. Thornton paid $10,000 for the operation.

附註:

靜脈攝影檢查及相關處置之目的：為診斷靜脈疾病或靜脈疾病的治療例如狹窄靜脈做靜脈擴張治療、靜脈血栓症做藥物灌注溶解血栓、或置放下腔靜脈過濾器預防肺動脈栓塞 (靜脈血栓術溶解術，靜脈血管擴張術、下腔靜脈過濾器置放術)。

檢查方式及步驟：靜脈攝影術是指將導管置入人體靜脈血管內，一般四肢靜脈攝影後手背、手腕、上臂、足背、下腿或鼠蹊部靜脈將頭皮針或塑膠管針置入靜脈，接著注射顯影劑照像，來診斷靜脈疾病或進一步治療靜脈相關疾病的一種診療技術。在注射顯影劑進行攝影時，會有「灼熱感」。這是正常現像。需進一步做相關治療處置時會使用特殊的導管，金屬導線，氣球擴張導管，及注入要灌注的藥劑。檢查完成後醫師會將頭皮針或塑膠管針拔出，並以手指壓住傷口止血並用膠帶黏貼。

以上, 再度謝謝Maggie和曉昌的大力幫忙!!
願大家都能夠痊癒!! May the force be with us!!

靜脈血管窄化的議題小結論