超声影像评价大隐静脉曲张患者下肢静脉形态与功能变化的相关性研究  

Study on morphological and functional changes of lower limbs veins by ultrasound evaluation in the patients with great saphenous vein varicosis

作　　者：邱璇[1] 张莉[1] 阴继凯[2] 许磊[1] 杨一林[1] 袁丽君[1] 段云友[1] 

机构地区：[1]第四军医大学唐都医院超声诊断科,西安市710038 [2]第四军医大学唐都医院普外科,西安市710038

出　　处：《中华全科医学》2015年第7期1163-1165,1184,F0003,共5页Chinese Journal of General Practice

摘　　要：目的 超声评价大隐静脉（great saphenous vein,GSV）曲张患者下肢静脉形态及功能变化,分析其与临床症状,及受累静脉之间相关性。方法 搜集GSV曲张患者107例（患肢150条）作为病例组,依据临床症状分级;20名健康成年人（健康腿40条）作为对照组,超声检查追踪显示GSV全程,记录受累静脉部位及各超声影像学参数,评价瓣膜功能,统计学分析各参数变化及相关关系。结果 病例组患肢GSV内径明显增宽,静脉远心端血栓检出率6.67%（10/150）,均见于C5~6级患者;94.67%（142/150）的下肢静脉曲张患肢中存在GSV瓣膜功能不全,其中瓣膜功能重度不全123条,不同临床分级中所占比例差异无统计学意义（P〉0.05）。患肢存在穿静脉开放者114条,占76%;共检出开放穿静脉185条,95.1%（176/185）为Cockett穿静脉。穿静脉开放数目与其内径及有无反流呈显著性正相关（r=0.3674,r=0.2764,P〈0.01）;穿静脉存在反流表明GSV瓣膜功能越差（r=-0.2443,P=0.0026）。结论 穿静脉开放参与影响GSV及FV血流动力学变化,影响患者临床症状分级,超声全面评价受累静脉形态及功能变化有助于客观评价静脉曲张病变,从而为其治疗提供诊断依据。Objective To investigate the correlation between the venous morphological and functional changes of involved veins and the clinical manifestations in the patients with varicosis of great saphenous vein （GSV）. Methods 107 patients with 150 involved legs being diagnosed as great saphenous varicosis were graded by clinical manifestations. 20 normal peo- ple （40 healthy legs） were collected as controls. The GSVs were traced along its route underwent ultrasound examination, and corresponding uhrasonographic variables were recorded. The function of the involved veins was evaluated. The differ- ence and correlation were analyzed by statistical analysis. Results In the patient group, the diameter of GSVs was much wider in the grade C5 _ 6 （ P 〈 0.01 ）, and 6.67 % （10/150） of them were detected with thrombus in distant part. There were 94.67% （142/150）patients with malfunctions of GSV valve,in which 123 legs was diagnosed as serious malfunctions （P 〉 0.05 ）. 114 cases（ accounting 76% ） were detected with the openness of perforating veins and total 185 opened perfora- ting veins were Cocket veins. The numbers of perforating veins were positively correlated with their diameters and the num- ber of perforating veins with or without reflux（ r = 0. 3674, r = 0. 2764, P 〈 0.01 ）. The valve function of GSVs impaired when blood reflux was detected in perforating veins （ r = - 0.2443, P = 0. 0026 ）. Conclusion The morphological and functional changes of perforating veins affected the hemodynamic changes of GSVs and femoral veins ,which led to the dif- ferent grades of clinical manifestation. Ultrasound imaging being capable of reflecting all the involved veins in patients with GSV varicosis can help the clinical diagnosis and treatment decision-making.

关 键 词：静脉曲张 浅静脉瓣膜功能不全 穿静脉 彩色多普勒 超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R543.6[医药卫生—诊断学]