穿支静脉在原发性下肢静脉功能不全中的作用

Significance of perforating vein in primary lower extremity venous insufficiency

目的 探讨穿支静脉(PV)在原发性下肢静脉功能不全中的作用。方法 收集2020年3月至2022年3月空军军医大学西京医院就诊的863例(1225条患肢)原发性下肢静脉功能不全患者的临床资料。根据临床表现-病因学-解剖学-病理生理学(CEAP)分级将患者分为早期(C0~C2级)组418例患者650条患肢、进展期(C3~C4级)组360例患者490条患肢、终末期(C5~C6级)组85例患者85条患肢;根据是否伴有可检测到PV将患者分为PV组514例患者810条患肢与NPV组349例患者415条患肢。应用彩色多普勒超声诊断仪对患者进行下肢静脉系检查并记录下肢深静脉(DV)、浅静脉(SV)及穿支静脉的管径、是否有反流、反流模式,分析不同临床阶段、不同反流模式下穿支静脉血流动力学变化。结果 早期组以女性患者居多,而进展期组、终末期组以男性患者居多。进展期组患者年龄、体重、体重指数(BMI)、静脉症状调查问卷(HASTI)评分、静脉临床严重程度评分(VCSS)均高于早期组患者,终末期组患者身高、体重、BMI、HASTI评分、VCSS均高于进展期组患者,进展期组患者久站时间长于早期组患者,差异均有统计学意义(P<0.05)。PV组患者HASTI评分、VCSS均高于NPV组患者,差异均有统计学意义(P<0.05)。PV组CEAP分级为C0~C2级的患者占48.77%(395/810),低于NPV组的61.45%(255/415),差异有统计学意义(P<0.05)。早期组患者反流模式以SV合并PV反流为主(45.8%),进展期组、终末期组患者反流模式以SV合并PV及DV为主,分别为55.6%、73.6%,3组患者反流模式比较,差异均有统计学意义(P<0.05)。随着疾病的进展,血流的PV数量逐渐增加,舒张期PV血流由DV向SV的外向流动也逐渐增加(P<0.05)。结论 PV作为下肢DV与SV之间的连接静脉,其血流动力学随着疾病进展而变化,PV的血流动力学表现主要由原发性下肢静脉瓣膜的反流模式决定,其本身并不发挥作用,仅为下肢深静脉系与浅静脉系间的“压力平衡装置”。

Objective To investigate the significance of perforating vein(PV) in primary lower extremity venous insufficiency. Method A total of 863 patients(1225 limbs) with primary lower extremity venous insufficiency treated in Xijing Hospital, Air Force Military Medical University from March 2020 to March 2022 were selected. They were divided into groups based on clinical etiology anatomy pathophysiology(CEAP) classification system including early stage(C0-C2) group(n=418, 650 limbs), advanced stage(C3-C4) group(n=360, 490 extremities), and terminal stage(C5-C6) group(n=85, 85limbs);they were divided into PV group(n=514, 810 extremities) and NPV group(n=349, 415 extremities) according to the presence or absence of detectable PV. The venous system of the lower extremity was examined by color Doppler ultrasound,the diameters, reflux patterns of the deep veins(DV), superficial veins(SV) and PV were recorded, the hemodynamic changes of PV in different clinical stages and different reflux patterns were analyzed. Result Most of the patients in the early stage group were women, while most of the patients in the advanced stage group and the terminal stage group were men. The age,weight, body mass index(BMI), heaviness ache swelling throbbing itching(HASTI) score and venous clinical severity score(VCSS) of the patients in the advanced group were higher than those in the early group, the height, weight, BMI, HASTI score and VCSS of the patients in the terminal group were higher than those in the advanced group, the patients in the advanced group had longer standing time than those in the early group, the differences were statistically significant(P<0.05). The score of HASTI and VCSS in PV group were higher than those in NPV group, the differences were statistically significant(P<0.05). The CEAP grade of C0-C2 in PV group was 48.77%(395/810), lower than that in NPV group of 61.45%(255/415),the difference was statistically significant(P<0.05). The reflux pattern of patients in the early stage group was mainly SV combined with PV reflux(45.8%), the reflux pattern of patients in the advanced stage group and the terminal stage group was mainly SV combined with PV and DV(55.6% and 73.6%, respectively), the differences between the reflux patterns of patients in the three groups were statistically significant(P<0.05). With the progress of the disease, the number of PV in blood flow gradually increased, and the outward flow of PV blood flow from DV to SV in diastole also gradually increased(P<0.05).Conclusion The PV is the connecting vein between the DV and the SV of the lower extremity, the hemodynamic performance varies with the development of the disease, and the hemodynamic performance of the PV is mainly caused by the reflux pattern of the primary lower extremity venous valve, which doesn’t participate in the role itself, the perforator vein is only a "pressure balance device" between the DV and SV system of the lower extremity.