85例复发性下肢静脉曲张影像学检查相关分析

An analysis of the imaging information of 85 patients with recurrent varicose veins in lower extremity

目的探讨与复发性下肢静脉曲张有关联的危险因素。方法基于血流动力学回顾性分析山东大学第二医院2013年6月至2018年6月收治复发性下肢静脉曲张患者85例(85条肢体)的临床资料。根据彩色多普勒超声和CT影像学检查结果,分析病例的复发原因。以临床表现-病因学-解剖-病理生理静脉分类系统(clinical, etiological, anatomical, pathophysiological classification, CEAP)的临床分级作为应变量,应用有序Logistic回归,分析应变量与复发原因的相互关系,探讨下肢静脉曲张术后复发的相关危险因素。结果 85例患者中大隐静脉主干与属支的残留或再通者占37.6%,静脉管腔狭窄或阻塞者占30.6%,穿通静脉功能不全者占23.5%,小隐静脉功能不全者占8.2%。通过Logistic回归分析,穿通静脉功能不全(OR=10.465,95%CI:2.980~36.782,P<0.001)、深静脉系统狭窄(OR=9.554,95%CI:2.933~31.094,P<0.001)、复发时间(OR=1.684,95%CI:1.335~2.123,P<0.001)以及年龄(OR=0.930,95%CI:0.877~0.985,P=0.014)对复发性下肢静脉曲张的CEAP临床分级的影响差异有统计学意义;而性别(OR=1.068,95%CI:0.439~2.596,P=0.885)和大隐静脉主干残留(OR=0.758,95%CI:0.239~2.406,P=0.638)对复发性下肢静脉曲张的CEAP临床分级差异无统计学意义。结论穿通静脉功能不全、深静脉系统狭窄和复发时间是复发性下肢静脉曲张的独立危险因素;年龄因素是复发性下肢静脉曲张的保护因素。

Objective To investigate the risk factors of recurrent varicose veins in lower extremity. Methods The hemodynamic data of 85 patients(85 limbs) with recurrent varicose veins in lower extremity treated during June 2013 and June 2018 were retrospectively analyzed. The color Doppler ultrasound and CT imaging results were analyzed to investigate the causes of recurrence. The classification in clinical, etiological, anatomical, pathophysiological classification(CEAP) was used as the dependent variable. The relationship between the dependent variable and causes of recurrence was analyzed with ordinal logistic regression, and the risk factors of recurrence were explored. Results In 85 patients, 37.6% had residual or recanalization of the great saphenous vein and its branches, 30.6% had venous stenosis or obstruction, 23.5% had penetrating venous insufficiency, and 8.2% had small saphenous vein insufficiency. Logistic regression analysis showed that penetrating venous insufficiency(OR=10.465, 95%CI: 2.980-36.782, P<0.001), deepvenous system stenosis(OR=9.554, 95%CI: 2.933-31.094, P<0.001), recurrence time(OR=1.684, 95%CI: 1.335-2.123, P<0.001) and age(OR=0.930, 95%CI: 0.877-0.985, P=0.014) had statistically significant effects on the CEAP classification of recurrent varices, while gender(OR=1.068, 95%CI: 0.439-2.596, P=0.885) and residual great saphenous vein(OR=0.758, 95%CI: 0.239-2.406, P=0.638) had no significant effects. Conclusion Perforating venous insufficiency, deep venous stenosis and recurrence time are independent risk factors while age is a protective factor for recurrent lower extremity varices.