多层螺旋CT多平面重建髂静脉压迫特征和分型的研究

doi:10.3760/cma.j.cn101202-20190610-00189

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摘要目的探讨多层螺旋CT(MSCT)多平面重建(MPR)无下肢症状的髂静脉压迫人群的髂静脉压迫特征和分型。方法采用回顾性横断面研究方法。收集2018年6月—10月浙江中医药大学附属第一医院全腹部或下腹部MSCT增强扫描中发现存在髂静脉压迫的200例无下肢疾病症状受检者,其中男92例、女108例,年龄18~92岁。分析受检者的左、右侧髂静脉的压迫类型、压迫点个数、最大压迫部位及发生率;测量最大压迫部位髂静脉短径、面积、近远端1 cm髂静脉面积、压迫范围、髂总静脉与下腔静脉的夹角,计算最大压迫部位髂静脉狭窄率。应用SPSS 25.0软件,采用独立样本t检验、秩和检验和χ²检验对数据进行统计分析。分析指标:(1)比较左、右侧髂静脉压迫的部位及定量指标测量值;(2)左侧及右侧髂总静脉压迫的不同年龄、性别、面积、狭窄率的差异;(3)左、右侧髂总静脉不同狭窄程度时的性别差异;(4)髂静脉压迫分型的基本特征及各型之间定量特征。结果 (1)最大压迫部位:位于左髂总静脉180例、右髂总静脉56例、下腔静脉分叉处10例、左髂外静脉7例、左髂总静脉分叉处3例和右髂外静脉1例;左髂总静脉受压占比(90.0%)较右髂总静脉(28.0%)高,差异有统计学意义(χ²=158.909, P＜0.01),但不同年龄段(＜65岁与≥65岁)间差异无统计学意义(χ²=0.058, P＞0.05);左、右侧髂静脉压迫的面积、狭窄率比较,差异无统计学意义(P值均＞0.05);正交断面上左、右侧髂总静脉最大压迫部位短径分别为(6.0±2.6)、(8.3±2.8)mm,压迫范围分别为(11.2±2.1)、(10.0±2.4)mm,同侧髂总静脉与下腔静脉延长线的夹角分别为38.8°(20.2°)、17.7°(9.2°),差异均有统计学意义(P值均＜0.01)。(2)在＜65岁和≥65岁年龄段者的女性的左、右侧髂总静脉受压面积均小于男性,差异均有统计学意义(P值均＜0.05),而狭窄率差异均无统计学意义(P值均＞0.05)。(3)左、右侧髂总静脉狭窄程度≥25%和≥50%时,男女性别构成差异均无统计学意义(P＞0.05)。(4)髂静脉压迫分型:Ⅰ型,左髂总静脉单一压迫占20.5%(41/200);Ⅱ型,左髂总静脉双重压迫,占36.5%(73/200);Ⅲ型,左右髂总静脉双侧压迫,占23.5%(47/200)、Ⅳ型,其他压迫类型,占19.5%(39/200)。各型间年龄、性别、狭窄率构成比较,差异均无统计学意义(P值均＞0.05),压迫点个数比较差异有统计学意义(P＜0.01)。结论无下肢症状的髂静脉受压人群MSCT多平面重建显示髂静脉受压部位不固定,左侧髂总静脉受压发生率最高,其次是右侧髂总静脉受压,可将髂静脉受压情况分为四种类型(Ⅰ~Ⅳ型),其中以Ⅱ型左髂总静脉双重压迫最为常见。

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	李嘉颖
	孙志超
	许茂盛
	陈武杰
	周科峰
	陈海波
	徐志超
	孙尚龙
	陈刚
	王舒婷

关键词 ：髂静脉, 髂静脉压迫综合征, 分型, 体层摄影术,螺旋计算机, 多平面重建技术

Abstract：Objective To study the features and classifications of iliac vein compression among population without lower extremity symptoms by multi-planner reconstruction (MPR) with multi-slice spiral CT (MSCT).Methods The imaging data of 200 asymptomatic individuals who underwent enhanced abdominal MSCT examination in the First Affiliated Hospital of Zhejiang Chinese Medical University from June to October in 2018 were collected based on retrospective cross-sectional method. There were 92 males and 108 females aged from 18 to 92 years. The type of iliac vein compression, the number of compression point, the site and incidence of maximum compression point were observed. The short diameter and area of the maximum compression of the iliac vein at the point where the iliac artery crossed, the area of the iliac vein proximal and that distal 1 cm to the maximum compression point, the range of compression, the angle between the common iliac vein and the inferior vena cava bilaterally and the stenosis rate of the iliac vein at the maximum compression point were measured. Statistical significance was tested by using Student's t-test, Rank sum test, Chi-square test on the SPSS 25.0 software. Analysis factors: (1) comparing the position and quantitative characteristics of left and right iliac vein compression; (2) the compression area and stenosis rate differences in age and gender of left and right common iliac vein; (3) the gender difference in the degree (≥25%, ≥50%), of left and right common iliac vein stenosis; (4) the basic features of iliac vein compression subtypes and quantitative features among them.Results (1) The site of maximum compression point included the left common iliac vein (LCIV)180 cases, the right common iliac vein (RCIV) 56 cases, the bifurcation of the inferior vena cava (IVC) 10 cases, the left external iliac vein (LEIV) 7 cases, the bifurcation of the left common iliac vein (LCIV) 3 cases and the right external iliac vein (REIV) 1 case. The incidence of LCIV compression (90.0%) was higher than the RCIV (28.0%), there was statistically significant difference(χ²=158.909, P<0.01); but there was no statistically significant difference between the age(χ²=0.058, P＞0.05). There was no significant difference in the area and stenosis rate of left and right iliac vein compression (all P values＞0.05). Based on the maximum compression point in the orthogonal cross-sectional plane, the left/right iliac vein of the short diameter, the range of compression, the angle between the left and right common iliac vein and IVC, the stenosis rates were (6.0±2.6) mm and (8.3±2.8) mm, (11.2±2.1) mm and (10.0±2.4) mm, 38.8°(20.2°) and 17.7°(9.2°), respectively, the differences were statistically significant (all P values＜0.01). (2) Compared with the compression area and stenosis rate of left and right common iliac vein of different ages and genders, the compression area of females was smaller than that of males (P<0.05), and the stenosis rate was not statistically significant (P＞0.05). (3)There was no significant gender difference in the degree (≥25% and ≥50%, respectively) of left and right common iliac vein stenosis (all P values＞0.05). (4) The type of iliac vein compression could be classified into four classifications: typeⅠwas the left common iliac vein single compression (41/200), type Ⅱ was the left common iliac vein double compression (73/200), type Ⅲ was the both left and right common iliac vein compression (47/200), type Ⅳwas the other compression type (39/200). There was no statistically significant difference in age, gender and stenosis rate among different types (all P values＞0.05), and the difference in the number of compression points was statistically significant (all P values＜0.01).Conclusions To observe the iliac vein compression in asymptomatic patients under the multi-plane reconstruction of MSCT. It is found that the iliac vein is not fixed. The incidence of iliac vein compression in the left side is the highest, followed by that in the right side. The type of iliac vein compression could be divided into four classifications (Ⅰ-Ⅳtype), and the typeⅡdouble compression of left common iliac vein is the most common type. To provide help for early diagnosis of iliac vein compression syndrome and individualized treatment.

Key words： Iliac vein Iliac vein compression syndrome Classification Tomography, spiral computed Multi-planar reconstruction

收稿日期: 2019-06-10

基金资助:浙江省自然科学基金(LSY19H030001、LGD19C040002)

通讯作者: 孙志超,Email:szcdoctor@163.com

引用本文:

李嘉颖, 孙志超, 许茂盛, 陈武杰, 周科峰, 陈海波, 徐志超, 孙尚龙, 陈刚, 王舒婷. 多层螺旋CT多平面重建髂静脉压迫特征和分型的研究[J]. 中华解剖与临床杂志, 2020, 25(2): 109-115.
Li Jiaying, Sun Zhichao, Xu Maosheng, Chen Wujie, Zhou Kefeng, Chen Haibo, Xu Zhichao, Sun Shanglong, Chen Gang, Wang Shuting. Study on the features and classifications of the iliac vein compression by multi-planar reconstruction imaging with multi-slice spiral CT. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 109-115.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190610-00189 或 http://www.cjac.com.cn/CN/Y2020/V25/I2/109

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