髂静脉压迫综合征患者髂静脉、下腔静脉间压力差的测定

Determination and Application of Pressure Difference between Iliac Vein and Inferior Vena Cava in Patients with Iliac Vein Compression Syndrome

目的:测定髂静脉压迫综合征合并下肢静脉曲张患者双下肢的髂静脉、下腔静脉压力,计算压力差(髂腔静脉压力差),并探讨髂腔静脉压力差对治疗的指导意义。方法:2011年6月—2013年6月经MRV确诊的髂静脉压迫综合征患者32例,均合并同侧下肢静脉曲张。32例患者均行数字减影血管造影(digital subtraction angiography,DSA)检查,测定静息状态下双侧(患侧及健侧)髂静脉压力、下腔静脉压力,并计算压力差;同时行下肢曲张静脉的高位结扎术及激光闭合手术。结果:DSA造影结果显示,12例受压髂静脉管径增宽、密度减淡,2例受压段髂静脉充盈缺损,3例受压段髂静脉有分隔形成,21例伴有明显的侧枝循环,12例静脉排空延迟,5例未见明显异常。髂腔静脉测压结果显示,健侧髂腔静脉压力差为(1.1.406±0.0985)cmH_2O,患侧髂腔静脉压力差为(1.3594±0.1510)cmH_2O,两侧静脉压力差均小于2 cmH_2O,差异无统计学意义(P>0.05)。术后随访,未发现复发或加重病例;合并静脉淤滞性溃疡患者的手术满意度最高,达83.3%。结论:若髂静脉压迫综合征合并下肢静脉曲张患者在静息状态下健侧与患侧的髂腔静脉压力差的差异无统计学意义,即可认为髂静脉受压尚未造成患肢的血流动力学的改变或已代偿,故无需处理受压迫及狭窄的髂静脉,只需行下肢静脉曲张手术,即可达到良好效果。测定静息状态下髂腔静脉压力差可为髂静脉压迫综合征合并下肢静脉曲张患者的治疗提供参考。

Objective：To determine the pressure of the iliac vein and inferior vena cava of bilateral lower limbs in patients with iliac vein compression syndrome complicated by venous varicosities of lower extremity,calculate the pressure difference（between iliac vein and inferior vena cava）,and explore the guiding significance of pressure difference in treatment.Methods：From June 2011 to June 2013,a total of 32 cases of iliac vein compression syndrome complicated by venous varicosities of ipsilateral lower extremity were diagnosed by MRV.All the 32 cases underwent DSA,the iliac venous and Inferior vena cava pressure of whom were measured bilaterally （ipsilateral and contralateral） and the pressure difference was calculated.Meanwhile,high ligation combined with laser closure was performed in the treatment of varicose veins of lower extremity.Results：The results of DSA showed widened diameter and degraded density of compressed iliac vein in 12 cases,filling defect in compressed section of iliac vein in 2 cases,emerged separation in compressed section of iliac vein in 3 cases,obvious collateral circulation in 21 cases,delayed venous emptying in 12 cases,and no obvious abnormity in 5 cases.The measured pressure of iliac vein and inferior vena cava：The pressure difference between contralateral iliac veins and inferior vena cava was （1.1406 ± 0.0985）cmH2O,while the pressure difference between the ipsilateral iliac veins and inferior vena cava was （1.3594 ± 0.1510）cmH2O.Bilateral venous pressure differences were less than 2 cmH2O.There was no statistically significant difference （P〉0.05）.The results of postoperative follow-up：In all patients,there was no recurrence or aggravation.The highest satisfaction score,which reached 83.3%,was found among the patients with venous stasis ulcer.Conclusions：If there was no significant difference between the ipsilateral and the contralateral pressure differences,which existed between the iliac vein and inferior vena cava,in patients with iliac vein compression syndrome complicated by venous varicosities of lower extremity under resting state,then it could be considered as no hemodynamic change of the affected limbs or compensated status.Therefore,the good effect could be achieved by surgical operation on lower extremity without doing with the compressed and stenosed iliac vein.Determination of pressure difference between iliac vein and inferior vena cava under resting state could provide reference for the treatment of the patients with iliac vein compression syndrome complicated by venous varicosities of lower extremity.