左侧下肢静脉曲张患者左髂总静脉受压的CT影像研究

doi:10.3760/cma.j.cn101202-20190514-00162

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摘要目的探讨左下肢静脉曲张患者左侧髂总静脉受压迫情况,以及左髂总静脉狭窄与性别、年龄的关系及其临床意义。方法收集2013年11月—2019年2月在南通大学第三附属医院行下肢静脉CT造影(CTV)的263例左侧下肢静脉曲张患者的CTV资料进行回顾性分析。其中男144例、女119例,年龄18～88(61.9±11.9)岁。将患者按年龄分为18～45、46～55、56～65、66～75和≥76岁组。在CTV矢状位重建图像上,分别测量左髂总静脉受压点及受压点近心端、远心端各1 cm处的前后径D1、D2、D3,并计算左侧髂总静脉狭窄率(Dsr)。比较不同性别、年龄组间左侧Dsr。依据左侧Dsr值将狭窄程度分为Dsr＜25%、25%≤Dsr＜50%、Dsr≥50%,评估不同狭窄程度与年龄之间的关系。结果 263例左下肢静脉曲张患者Dsr为22.0%(13.5%,31.8%),其中Dsr≥50% 21例(8.0%),25%≤Dsr＜50% 77例(29.3%),Dsr﹤25% 165例(62.7%)。男性18～45、46～55、56～65、66～75、≥76岁组Dsr分别为34.6%±16.7%、25.8%±14.8%、20.0%±11.6%、16.6%±10.9%、17.2%(13.8%,21.1%),女性分别为24.6%(21.7%,41.8%)、24.4%(19.9%,33.0%)、27.6%±18.2%、22.7%±18.6%、16.9%±13.5%。总体女性患者Dsr大于男性患者(Z=-2.165, P<0.05)。相同年龄组不同性别间比较,仅56~65岁组女性患者Dsr大于男性患者(t=-2.199, P＜0.05),其余各年龄组Dsr性别间差异均无统计学意义(P值均＞0.05)。男性不同年龄组间比较:Dsr随着患者年龄的增加呈下降趋势,差异有统计学意义(F=5.818, P＜0.01);两两比较显示,18～45岁组的Dsr明显大于其余各年龄组,差异均有统计学意义(P＜0.01),其余年龄组间Dsr差异均无统计学意义(P值均＞0.05)。女性患者不同年龄组间Dsr比较,差异无统计学意义(F=1.842, P＞0.05)。男性、女性及总体Dsr均与年龄呈负相关(r_男性=-0.305、r_女性=-0.244、r_总体=-0.272, P＜0.01)。左侧髂总静脉狭窄程度与不同年龄组间存在线性趋势关系,且为负相关(χ²=13.215, R=-0.225, P值均＜0.01)。结论随着年龄的增大,左下肢静脉曲张患者左侧髂总静脉狭窄严重程度逐渐降低;年轻男性患者Dsr最大。对左侧下肢静脉曲张患者应检查左髂总静脉受压情况,狭窄率≥50%时应同时行左侧髂总静脉血管腔内治疗,解除左侧髂总静脉压迫情况。

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	崔晋
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关键词 ：静脉曲张, 左髂总静脉, 髂静脉压迫综合征, 静脉造影术

Abstract：Objective To investigate the compression of left common iliac vein in patients with varicose veins of left lower extremity and the relationship of sex and age on the stenosis rate of left common iliac vein and its clinical significance.Methods From November 2013 to February 2019, 263 patients with varicose veins of left lower extremity underwent lower extremity CT angiography(CTV) in the Third Affiliated Hospital of Nantong University were retrospectively analyzed. There were 144 males and 119 females, aged from 18 to 88 (61.9±11.9) years. Patients were divided into 18-45 years old group, 46-55 years old group, 56-65 years old group, 66-75 years old group and ≥76 years old group. On the sagittal reconstruction image of CTV, the anteroposterior diameters D1, D2 and D3 of the left common iliac vein were measured respectively at the compression point and the pressure point at the proximal and distal ends of the vein at 1 cm each. The rate of left common iliac vein stenosis (Dsr) was calculated. The left Dsr was compared among different genders and age groups. Based on the left Dsr, the patients were divided into Dsr＜25%, 25%≤Dsr＜50%, Dsr≥50%. To assess the relationship between the degree of left common iliac vein stenosis and age.Results The left Dsr was 22.0%(13.5%,31.8%) in 263 patients with varicose veins of left lower extremity. Based on the left Dsr, Dsr﹤25% 165 patients, 25%≤Dsr＜50% 77 patients, Dsr≥50% 21 patients. The Dsr of males were 34.6%±16.7%, 25.8%±14.8%, 20.0%±11.6%, 16.6%±10.9% and 17.2%(13.8%, 21.1%), in female, they were 24.6%(21.7%, 41.8%), 24.4%(19.9%, 33.0%), 27.6%±18.2%, 22.7%±18.6% and 16.9%±13.5%, in the 18-45, 46-55, 56-65, 66-75 and ≥76 years old groups, respectively. There was no statistically significant difference in Dsr between different genders in the same age group (all P values＞0.05). Comparison between different age groups: Dsr of male patients showed a decreasing trend with the increase of age, and the difference was statistically significant (F=5.818, P＜0.01). Dsr of the 18-45 age group was significantly larger than that of other age groups, with statistically significant differences (all P values＜0.05). There was no significant difference in Dsr between other age groups (all P values＞0.05). There was no significant difference in Dsr between different age groups of female patients (P＞0.05). Male, female and overall Dsr were negatively correlated with age (r_male=-0.305, r_female=-0.244, r_population=-0.272, all P values＜0.01). The degree of left iliac vein stenosis was negatively correlated with the degree of left iliac vein stenosis in different age groups (χ²=13.215, R=-0.225, all P values＜0.01).Conclusions With the increase of age, the severity of left iliac vein stenosis decreases gradually. Young men have the largest Dsr. For patients with varicose veins of the left lower extremity, the compression of the left common iliac vein should be checked. When the stenosis rate is ≥50%, endovascular treatment of the left common iliac vein of the left iliac vein should be performed simultaneously to relieve the compression of the left common iliac vein of the left iliac vein.

Key words： Varicose veins Common iliac vein Iliac vein compression syndrome Phlebography

收稿日期: 2019-05-14

通讯作者: 姜建威,Email:weij85@163.com

引用本文:

崔晋, 于婷, 郭晶晶, 殷允娟, 吴清华, 姜建威. 左侧下肢静脉曲张患者左髂总静脉受压的CT影像研究[J]. 中华解剖与临床杂志, 2020, 25(2): 116-122.
Cui Jin, Yu Ting, Guo Jingjing, Yin Yunjuan, Wu Qinghua, Jiang Jianwei. CTV study of compression degree of left common iliac vein in patients with varicose veins of left lower extremity. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 116-122.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190514-00162 或 http://www.cjac.com.cn/CN/Y2020/V25/I2/116

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