下肢静脉影像学检查在静脉功能不全术前评估中的研究进展

The research progress of imaging examination of lower extremity vein for the preoperative assessment of patients with chronic venous insufficiency

下肢慢性静脉功能不全(CVI)治疗方法较多,主要包括隐静脉高位结扎抽剥、内镜深筋膜下穿通静脉离断术(SEPS)、腔内电凝治疗、腔内激光治疗(EVLT)、腔内射频治疗、皮下曲张静脉透光旋切术,以及深静脉瓣膜修复术、腘静脉肌襻代瓣术。为实施有效治疗和减少并发症,对下肢静脉系统进行术前评估尤为重要。目前评估方法主要包括下肢顺行静脉造影、彩色多普勒超声(CDUS)、计算机断层扫描静脉造影(CTV)和磁共振成像静脉造影(MRV)。然而,上述方法均有其局限性。下肢顺行静脉造影操作简便、安全易行、成本低廉,联合CDUS可以全面评估下肢静脉的解剖异常和反流,准确定位瓣膜功能不全的穿通静脉,适合在临床进一步推广。

Treatment of chronic venous insufficiency （CVI） is various, mainly including saphenous vein ligation and stripping, subfascial endoscopic perforator vein surgery （SEPS）, endovenous electrocoagulation treatment, endovenous laser treatment （EVLT）, endovenous radiofrequency geatment, TriVex therapy, and deep venous valve repair, popliteal vein loop surgery. For the effective treatment and the reduction of complicatiom, preoperative assessment of all lower extremity venous systems is particular important. The evaluation methods used at present are ascending venography, color Doppler ultrasonography （CDUS）, computed tomography venography （CTV） and magnetic resonance venography （MRV）. However, all these methods have their limitations. In general, ascending venography is simple, safe, convenient, and economic. When combined with CDUS examination, they can accurately assess anatomical abnormalities, reflux of the lower extremity vein, and locate the incompetent perforators. It＇s suitable for further promotion in clinical practice.