CT静脉造影在诊治复发性下肢静脉曲张的应用

Application of CT venography in the diagnosis and treatment of recurrent lower extremity varicose veins

目的探讨CT静脉造影(CTV)在复发性下肢静脉曲张的应用。方法分析山东大学第二医院2014年1月至2019年12月收治复发性下肢静脉曲张患者91例(91条肢体)临床资料,采集患者下肢CTV数据,进行三维重建;根据横断面影像和三维模型分析复发原因,并进行可视化手术预演,准确定位引起复发的罪犯血管。结合彩色多普勒超声,制定个体化治疗方案。根据术后疗效和随访结果,评价CTV技术在诊治复发性下肢静脉曲张的应用价值。结果 91例患者下肢CTV横断面影像和三维模型可明确复发原因,罪犯血管和毗邻组织清晰显示。依据患者不同病因行个体化手术治疗,术后下肢曲张静脉消失,溃疡愈合时间21(13.5~31.0)d;随访5~60个月,平均18(11~27)个月,无静脉曲张和溃疡复发。通过CTV测量髂静脉直径和瓣膜数量显著小于彩色多普勒超声(P<0.001),穿通静脉数量显著高于彩超(P<0.001)。结论 CTV技术有助于清晰判断下肢静脉曲张术后复发原因,准确定位引起复发的罪犯血管,提供术中路图信息,具有彩色多普勒超声无法替代的临床价值。

Objective To explore the application of computed tomography venography(CTV) in the diagnosis and treatment of recurrent lower extremity varicose veins. Methods The clinical data of 91 patients(91 limbs) with recurrent lower extremity varicose veins treated in our hospital during Jan. 2014 and Dec. 2019 were analyzed. The CTV data were collected and three-dimensional models were reconstructed. The causes of recurrence were analyzed with reference to the cross-sectional images and three-dimensional models, and the culprit veins causing recurrence were accurately located by previewing visualized surgeries. Individualized treatment plans were developed with the help of color Doppler ultrasound. The application value of CTV in the diagnosis and treatment of recurrent lower extremity varicose veins was evaluated based on curative effects and follow-up results. Results The cross-sectional images and three-dimensional models of CTV could identify the cause of recurrence and clearly display the culprit veins and adjacent tissues. After individualized surgeries, the varicose veins disappeared and ulcers healed in 21(13.5-31.0) days. During the follow-up of 5 to 60[average 18(11-27)] months, no varicose veins or ulcers recurred. The diameter of the iliac vein and number of valves measured by CTV were significantly smaller than those measured by color Doppler ultrasound(P<0.001), but the number of perforating veins was significantly larger(P<0.001). Conclusion CTV can help to clearly determine the cause of recurrence of varicose veins in lower extremities, accurately locate the culprit veins, and provide intraoperative road map information. It has clinical value that color Doppler cannot replace.