多层螺旋CT血管成像对髂总静脉汇合部的解剖研究

Anatomy study of the confluence of the common iliac vein using multi-slice spiral CT angiography

目的应用多层螺旋 CT 血管成像(CTA),探讨髂总静脉汇合部的解剖与髂静脉压迫综合征的关系。方法对无下肢血管闭塞性病变主诉和体征的80例患者行多层螺旋 CT 腹部增强扫描,采用多平面重组显示髂总静脉汇合部,测量右髂总动脉跨越处左髂总静脉前后径、两侧髂总静脉汇入下腔静脉的角度、横断面及正交断面上两侧髂总静脉的内径和面积,并对测量结果进行统计分析。结果横断面上两侧髂总静脉的平均内径、面积及其比值[右、左侧内径分别为(14.8±2.7)、(19.1±5.3)mm,面积分别为(171±61)、(244±112)mm^2,与下腔静脉内径比分别为0.79±0.12和1.03±0.30,与下腔静脉面积比分别为0.65±0.20和0.93±0.47]均大于正交断面[右、左侧内径分别为(14.1±2.3)、(15.6±3.5)mm,面积分别为(157±51)、(182±74)mm^2,与下腔静脉内径比分别为0.75±0.10和0.83±0.16,与下腔静脉面积比分别为0.59±0.19和0.68±0.25]相应数值(t=3.525～7.979,P 均<0.01)。正交断面左侧髂总静脉与下腔静脉内径比和面积比均大于右侧(t 值分别为13.030和10.942,P 均<0.01)。右侧髂总静脉汇入下腔静脉的夹角小于左侧(P<0.01)。在非老年(年龄<65岁)患者中,男性在右髂总动脉跨越处测量的左髂总静脉前后径及正交断面上的面积[分别为(9.2±3.5)mm和(209±63)mm^2]大于女性[分别为(6.0±3.1)mm 和(150±74)mm^2](t 值分别为3.120和2.880,P<0.01)。在老年(年龄t≥65岁)患者中,男性左髂总静脉正交断面面积及其与下腔静脉面积的比值[分别为(207±90)mm^2和(0.80±0.34)]大于女性[分别为(138±38)mm^2和(0.59±0.14)](t 值分别为2.811和2.245,P<0.05)。结论 CTA 能多平面显示髂总静脉汇合部的解剖,并可进行多方位准确测量,对髂静脉压迫综合征的诊断有临床应用价值。

Objective To study the image anatomy of the confluence of the common iliac vein using multi-slice helical CT angiography and to investigate the relationship between the confluence anatomy and the iliac vein compress syndrome. Methods Eighty cases without complaints and signs of lower extremity vascular occlusive diseases were evaluated with 16-slice helical CT angiography. Multiplanar reformation technique was performed to depict the confluence of the common iliac vein. Following anatomical measurements were performed： The anteroposterior diameter of the left common iliac vein was measured in the sagittal plane at the point where the right common iliac artery crossed. The angle between the common iliac vein and inferior vena cave bilaterally. The inner diameter and area of bilateral common iliac veins in the transactional and cross-sectional planes. The data were examined using t test. Results The mean inner diameters and areas and their relative values of the bilateral common iliac veins in the transaction the inner diameters of the right and left veins were （14. 8 ± 2.7 ）, （19. 1 ± 5.3 ） mm respectively; the areas were （171 ± 61 ）, （244 ± 112）mm^2 respectively; the ratios to the inner diameter of IVC were 0. 79 ± 0. 12 and 1.03 ± 0. 30 ; the ratios to the area of IVC were 0. 65 ± 0. 20 and 0. 93 ± 0. 47 ] exceeded those in the crosssection [ the inner diameters of right and left veins were （ 14. 1 ± 2. 3 ）, （ 15.6 ± 3.5 ） mm respectively; the areas were （157 ± 51 ）, （182 ± 74 ）mm^2 respectively; the ratios to the inner diameter of IVC were 0. 75 ±0. 10 and 0. 83±0. 16; the ratios to the area of IVC were 0.59±0. 19 and 0.68± 0.25] （t =3.525 to 7. 979 ,P 〈0. 01 ）. The mean inner diameter relative value to IVC and the area relative value to IVC of the left common iliac vein in the transaction exceeded those of the fight side （t = 13. 030,10. 942;P 〈 0. 01 ）. The angle between the right common iliac artery and IVC was less than that on the left side（P 〈0. 01 ）. The anteroposterior diameter in the sagittal plane and the area in the cross-section of the left common iliac vein at the point where the right common iliac artery crossed in male group under 65-year-old [ （9. 2 ±3.5 ） mm and （209 ±63） mm^2] exceeded those in female group [（6.0 ±3. 1）mm and（150 ±74）mm^2] （t =3. 120, 2. 880;P 〈0. 01）. The area and its relative value in the cross-section of the left common iliac vein at the point where the right common iliac artery crossed in male group over 65-year-old exceeded [ （207 ± 90）mm^2 and（0. 80 ± 0. 34 ） ] exceeded those in female group [ （ 138 ± 38 ） mm^2 and （0. 59 ± 0. 14 ） ] （ t = 2. 811, 2. 245 ;P 〈 0. 05 ）. Conclusion The confluence of the common iliac vein can be depicted and measured in multiple planes using multi-slice helical CT angiography, which has important implications in the diagnosis of iliac vein compress syndrome.