摘要
背景与目的:下肢静脉曲张是外周静脉病变的常见临床表现,可由下肢静脉反流性疾病、下肢静脉回流障碍性疾病、静脉畸形等多种疾病所致;不同病因导致的下肢静脉曲张其治疗原则也不尽相同。临床中常出现关于下肢静脉曲张的误诊误治,故明确其病因至关重要。目前下肢静脉造影仍是诊断下肢静脉病变的金标准,可提供完整的下肢静脉系统影像,为明确诊断及选择合适的治疗方案提供可靠依据。本研究总结江苏常州地区以下肢静脉曲张为主要临床症状的患者的下肢深静脉顺行造影结果,探讨造影在下肢静脉疾病中的意义,并分析该地区引起下肢静脉曲张的主要病因。方法:使用数字减影血管造影(DSA)技术,对苏州大学附属第三医院血管外科2013年6月—2019年3月收治的3012例(3420条肢体)下肢静脉曲张患者行下肢深静脉顺行造影,观察患肢踝部至盆腔段深静脉形态、通畅度,以及患者做Valsalva动作时造影剂的反流情况,对患者静脉曲张的病因进行分析和分类。结果:3420条肢体中,原发性下肢深静脉瓣膜功能不全1395条(40.79%),单纯浅静脉曲张1052条(30.76%),髂静脉受压综合征569条(16.64%),下肢深静脉血栓后综合征328条(9.59%),其他(双股静脉畸形、腘静脉瘤、深静脉瘤样扩张、先天性静脉曲张骨肥大综合征、布加综合征、盆腔肿瘤等)76条(2.22%)。结论:常州地区下肢静脉曲张患者的病因以下肢深静脉瓣膜功能不全、单纯浅静脉曲张及髂静脉受压为主。对于下肢静脉曲张病变,需明确病因才能制定合理的治疗方案;下肢深静脉顺行造影是明确下肢静脉曲张病因的可靠方法,并能检出腘静脉瘤、布加综合征等少见疾病,可有效避免误诊误治;其在下肢静脉病变中有重要的应用价值,可作为下肢静脉曲张疾病的常规检查方法。
Background and Aims:Varicose veins of the lower extremities are the common clinical manifestations of peripheral venous diseases,which can be caused by variety of diseases such as venous reflux diseases,venous reflux disorders of the lower extremities,and venous malformations.The treatment principles of varicose veins caused by different etiologies are also different.Misdiagnosis and mistreatment of varicose veins of the lower extremities often occur in clinical practice,so it is very important to determine the pathogeny of varicose veins.At present,venography of the lower extremity is still the gold standard for the diagnosis of venous diseases of the lower extremity,which can provide a complete image of the lower extremity venous system,and provide a reliable basis for the clear diagnosis and selection of the appropriate treatment scheme.The purpose of this study was to summarize the results of anterograde venography of deep vein of lower extremity in Changzhou,Jiangsu Province,and to evaluate the significance of venography,and to analyze the main etiologies of varicose vein in this region.Methods:From June 2013 to March 2019,3012 patients with varicose veins of the lower extremities(3420 limbs)who were admitted to the Department of Vascular Surgery of the Third Affiliated Hospital of Suzhou University underwent anterograde venography with digital subtraction angiography(DSA).The morphology and patency of the deep veins from the ankle of the affected limb to segment in the pelvic cavity,as well as the reflow of the contrast material while the patient was performing the Valsalva maneuver were observed.Then,the etiologies of varicose vein of the patients were analyzed and classified.Results:In the 3420 limbs,there were 1395 limbs with primary deep venous valve insufficiency(40.79%),1052 limbs with simple superficial varicose veins(30.76%),569 limbs with iliac vein compression syndrome(16.64%),328 limbs with post-thrombotic syndrome(9.59%),and 76 limbs(2.22%)with other pathogenies that included malformation of double femoral veins,popliteal venous aneurysm,deep venous aneurysm,Klippel-Trenaunay syndrome,Budd-Chiari syndrome and pelvic tumor.Conclusion:The lower extremity varicose veins in patients in Changzhou region is mainly caused by deep venous insufficiency,simple superficial venous valve insufficiency and iliac vein compression.The proper treatment scheme for lower extremity varicose veins is based on the identification of pathogeny.Deep venography of lower extremities is a reliable method for distinguishing the etiologies of lower extremity varicose veins,which can determine the uncommon diseases such as popliteal venous aneurysm and Budd-Chiari syndrome,and thereby effectively avoid misdiagnosis and mistreatment.So,it is of great application value in peripheral venous diseases and can be used as a routine examination for peripheral venous diseases.
作者
王鑫
张博闻
姜云飞
朱云峰
葛红卫
王惠
WANG Xin;ZHANG Bowen;JIANG Yunfei;ZHU Yunfeng;GE Hongwei;WANG Hui(Department of Vascular Surgery,the Third Affiliated Hospital of Soochow University,Changzhou,Jiangsu 213000,China;Department of Cardiology,the Third Affiliated Hospital of Soochow University,Jiangsu 213000,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第6期686-692,共7页
China Journal of General Surgery
基金
国家自然科学基金资助项目(81700351)。
关键词
静脉曲张
下肢
静脉功能不全
静脉造影术
血管造影术
数字减影
Varicose Veins
Lower Extremity
Venous Insufficiency
Phlebography
Angiography,Digital Subtraction