原发性浅静脉病变与慢性深静脉病变所致静脉溃疡伴发髂静脉阻塞情况的对比分析  

Comparative analysis of venous ulcer with iliocaval venous obstruction caused by primary superficial venous disease and chronic deep venous disease

作　　者：张名林 史键山 邓堂[1] 孙刚 金桂云[1] Zhang Minglin;Shi Jianshan;Deng Tang;Sun Gang;Jin Guiyun(Department of Vascular Surgery of Interventional,the First Affiliated Hospital of Hainan Medical College,Haikou 570100,Hainan,China)

机构地区：[1]海南医学院第一附属医院介入血管外科,海南海口570100

出　　处：《血管与腔内血管外科杂志》2021年第9期1026-1031,共6页Journal of Vascular and Endovascular Surgery

基　　金：海南省自然科学基金高层次人才项目(820RC764)。

摘　　要：目的对原发性浅静脉病变与慢性深静脉病变引起的静脉溃疡患者髂静脉阻塞(ICVO)发生情况进行对比分析。方法收集2020年1月至2021年6月于海南医学院第一附属医院就诊的64例静脉溃疡患者的临床资料,包括30例原发性浅静脉病变患者(A组)和34例慢性深静脉病变患者(B组)。经临床评估后,对于下肢活动性或愈合性静脉溃疡患者进行下肢双功能超声检查,以确定浅静脉、深静脉及穿通静脉是否存在病变,然后进行双侧下肢对比剂造影检查和血管内超声(IVUS)检查,以确定ICVO的存在及病变程度。结果64例患者中,有83条下肢表现为活动性或已愈合的静脉溃疡,包括A组38条患肢和B组45条患肢。静脉造影和IVUS检查结果显示,B组患者的静脉溃疡数量多于A组患者,溃疡持续时间长于A组患者,反流浅静脉最大直径小于A组患者(P<0.05)。83条患肢中,68条患肢(81.93%)的髂静脉狭窄或闭塞程度>50%;B组患者的髂静脉阻塞程度大于A组患者(P<0.05)。B组患者髂静脉阻塞>50%的发生率为88.89%(40/45),略高于A组患者的73.68%(28/38),但差异无统计学意义(P>0.05)。B组患者的髂外静脉阻塞更常见,且A组患者无腹壁静脉曲张,无血栓性阻塞,与B组患者比较,差异有统计学意义(P<0.05)。排除双侧下肢同时存在静脉溃疡者后,患侧肢和健侧肢非血栓性阻塞程度>50%的发生率分别为44.44%和24.44%,其中B组主要为血栓性栓塞,且患侧肢血栓性栓塞的发生率高于健侧肢,差异有统计学意义(P<0.01);A组无血栓性阻塞,但患侧肢非血栓性阻塞的发生率亦高于健侧肢(P<0.01)。两组患者的患侧肢髂静脉与下腔静脉压力差均高于健侧肢(P<0.01)。结论无论是原发性浅静脉还是血栓形成后深静脉病变引起的静脉溃疡,大多数患者都会伴发ICVO。Objective To compare and analyze the incidence of iliocaval venous obstruction(ICVO)in patients with venous ulcer caused by primary superficial venous disease or chronic deep venous disease.Method The clinical data of 64 patients with venous ulcer treated in the First Affiliated Hospital of Hainan Medical College from January 2020 to June 2021 were collected,including 30 patients with primary superficial venous disease(group A)and 34 patients with chronic deep venous disease(group B).After clinical evaluation,the patients with active or healing venous ulcer of lower limbs were examined by bifunctional ultrasound of lower limbs to determine whether there were lesions in superficial veins,deep veins and perforating veins,and then bilateral limb contrast agent contrast examination and intravascular ultrasound(IVUS)examination were performed to determine the existence and degree of lesions.Result Among the 64 patients,83 lower limbs showed active or healed venous ulcer,including 38 limbs in group A and 45 limbs in group B.The results of venography and IVUS showed that the number of venous ulcers in group B was more than that in group A,the duration of ulcer was longer than that in group A,and the maximum diameter of reflux superficial vein was smaller than that in group A(P<0.05).Of the 83 affected limbs,68(81.93%)had iliac vein stenosis or occlusion greater than 50%;the degree of iliac vein obstruction in group B was greater than that in group A(P<0.05).The incidence of iliac vein obstruction>50%in group B was 88.89%(40/45),which was slightly higher than 73.68%(28/38)in group A,but the difference was not statistically significant(P>0.05).External iliac vein obstruction was more common in group B,and there were no abdominal varices and thrombotic obstruction in group A compared with group B,the difference was statistically significant(P<0.05).After excluding the patients with venous ulcer in both lower limbs,the incidence of non thrombotic obstruction degree>50%in the affected limb and healthy limb were 44.44%and 24.

关 键 词：浅静脉曲张 慢性深静脉疾病 静脉溃疡 髂静脉阻塞 血管内超声检查 

分 类 号：R543[医药卫生—心血管疾病]