MSCTV在Cockett’s综合征中的诊治价值

MSCTV in the diagnosis and treatment of Cockett's syndrome

目的:探讨直接法下肢静脉血管成像(multi-slice computed tomography venography,MSCTV)在Cocke’s综合征中的临床意义。方法:回顾性分析应用直接法MSCTV诊断的Cocke’s综合征的影像特点,对髂总静脉受压节段进行管腔轴位重建,计算受压节段狭窄椭圆比,以1:3设定界值并根据是否伴有深静脉血栓形成分为I^III型,制定不同治疗方案,以下肢周径差及6个月随访结果评价治疗效果。结果:MSCTV诊断Cocke’s综合征35例,其中I型5例,表现为左髂总静脉局部受压变扁,管腔轴位椭圆比>1/3,狭窄远端静脉扩张伴或不伴侧支循环通路的建立,采用保守治疗。II型19例,表现为管腔明显狭窄,管壁呈明显弧形受压切迹,管腔轴位椭圆比≤1/3,采取介入治疗方案,其中5例行单纯球囊扩张术,14例行球囊扩张后支架植入治疗。III型11例,表现为管腔明显狭窄或节段性闭塞、狭窄处对比剂缺失或于管腔两侧线样通过,伴有不同程度的血栓形成,采用溶栓后支架植入术。35例患者治疗后临床症状恢复良好,1例患者术后6个月并发左股静脉节段性血栓形成,余无明确再狭窄及血栓复发征象,无肺动脉栓塞病例。结论:直接法MSCTV能对Cocke’s综合征做出准确诊断,并能通过后处理重建准确评估髂内静脉的受压程度及属支血管的病变情况,有利于制定合理的治疗方案。

Objective： To explore the effect of direct multi-slice computed tomography venography （MSCTV） on Cockett＇s syndrome. Methods： The imaging features of Cockett＇s syndrome diagnosed by direct MSCTV were retrospectively analyzed. The iliac vein compression tube segments were reconstructed axiall）n The ratio of the diameter of the lumen of pressure sections was calculated, and the boundary value was 1：3. According to the deep vein thrombosis, these data were divided into I-III types, the various therapeutic schemes were worked out, and the therapeutic effects were evaluated by the difference in diamete of lower limb before and after the treatment and 6-month follow-up. Results： Thirty-five patients with Cockett＇s syndrome were diagnosed by MSCTV, 5 of which were Type I, characterized by local mild compression with the left common iliac vein, diameter ratio 〉 1/3, with distal vein dilation or without collateral pathway, and conservative treatment adopted. Nineteen were Type II, with significantly narrow lumen, obviously oppressed wall, diameter ratio ≤ 1/3, and intervention programmes adopted. Five out of the 19 adopted routine simple balloon dilatation, and the other 14 had stent implantation. Eleven were Type III, with obvious venous lumen stenosis or segmental occlusion, contrast agent missing in narrow department or contrast medium like a thin line through both ends of the tube, meanwhile companied with different degrees of thrombosis, and thrombolytic therapy and stent implantation were carried out. All 35 patients recovered after the treatment, I with recurrent thrombosis in the femoral vein after 6 months, while the others had no clear signs of recurrent thrombosis and re-stenosis, There was no pulmonary embolism. Conclusion： Direct MSCTV can diagnoze the Cockett＇s syndrome accurately and assess the compression degree of the internal iliac vein and the lesion of vascular branches.