彩色多普勒超声与X线顺行静脉造影诊断下肢穿静脉瓣膜功能不全的对比研究

A comparative study on color Doppler ultrasonography and X-ray antegrade venography in diagnosis of lower extremity perforating venous valve insufficiency

目的与X线顺行静脉造影结果进行对比,探讨彩色多普勒超声(彩超)在小腿穿静脉检查中的作用价值。方法选取2014年1月—2016年3月临床诊断为大隐静脉曲张的53例患者(60条下肢),行彩超及X线顺行静脉造影检查,两者结果进行比较,并经手术证实。结果彩超与X线顺行静脉造影分别诊断小腿穿静脉瓣膜功能不全下肢47条和50条,两种检查方法比较差异无统计学意义(χ2=0.800,P=0.371);彩超共检出穿静脉78条,每条下肢检出穿静脉1~4条,其中穿静脉内径在2~5 mm者共66条,占84.6%,除2条<2 mm的穿静脉外,余均探及反流;其中距足底10~32 mm范围者(即足靴区)共73条,占93.6%;52条大隐静脉曲张下肢进行了大隐静脉高位结扎激光消融或+穿静脉离断术,与手术结果比较,彩超诊断穿静脉瓣膜功能不全下肢真阳性37条,假阳性2条,真阴性10条,假阴性3条,彩超诊断灵敏度为92.5%(37/40),特异度为83.3%(10/12),准确率为90.4%(47/52)。结论彩超可精确定位穿静脉,测量内径及观察反流程度,诊断穿静脉瓣膜功能不全敏感性及准确性高,安全、简便、经济,适于术前、术中诊断及定位。

Objective To investigate the value of color Doppler ultrasonography in the examination of perforating veins of the lower extremities by comparing with X-ray antegrade venography. Methods Fifty-three patients（60 lower extremities） clinically diagnosed with varicosis of the great saphenous vein from January 2014 to March 2016 were selected for color Doppler ultrasonography and X-ray antegrade venography. The results were compared and confirmed by surgery. Results Forty-seven lower extremities were diagnosed with perforating venous valve insufficiency by color Doppler ultrasonography, while 50 lower extremities by X-ray antegrade venography. There was no significant difference between the two methods（χ2=0.800, P=0.371）. A total of 78 perforating veins were detected by color Doppler ultrasonography, with 1–4 perforating veins per one lower extremity. Among them, 66 perforating veins had an internal diameter of 2–5 mm, accounting for 84.6%. Except two perforating veins with an internal diameter〈 2 mm, the rest showed reflux. In addition, a total of 73 perforating veins presented distance to the pelma of 10–32 mm（foot-boot）,accounting for 93.6%. Fifty-two lower extremities with varicosis of the great saphenous vein underwent laser ablation of the great saphenous vein with high ligation or ＋ devascularization of perforating veins. Compared with operation findings,color Doppler ultrasonography in diagnosis of perforating venous valve insufficiency had 37 true positives, 2 false positives, 10 true negatives and 3 false negatives, and the sensitivity was 92.5%（37/40）, the specificity was 83.3%（10/12）,the accuracy rate was 90.4%（47/52）. Conclusions Color Doppler ultrasonography can accurately localize perforating veins, measure the internal diameter and observe the degree of reflux. It is of high sensitivity and accuracy in the diagnosis of perforating venous valve insufficiency. Moreover, it is safe, simple and economical, and suitable for preoperative and intraoperative diagnosis and localization.