基于倾向性评分匹配的三维CT静脉造影与下肢静脉顺行造影对复发性静脉曲张评估效果的比较  

Comparison of three dimensional CT venography and ascending phlebography based on propensity score matching in the evaluation of recurrent varicose veins

作　　者：黄宜鹏 王甄妮 井宗旭 厉祥涛 张欢[1] 牛鹿原[1] 张福先[1] 罗小云[1] Huang Yipeng;Wang Zhenni;Jing Zongxu;Li Xiangtao;Zhang Huan;Niu Luyuan;Zhang Fuxian;Luo Xiaoyun(Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院血管外科,北京100038

出　　处：《中华外科杂志》2023年第12期1065-1073,共9页Chinese Journal of Surgery

基　　金：首都临床特色应用研究与成果推广项目(Z171100001017042)。

摘　　要：目的比较下肢三维CT静脉造影与下肢静脉顺行造影在评估复发性静脉曲张中的应用价值。方法回顾性收集2015年1月至2020年12月就诊于首都医科大学附属北京世纪坛医院血管外科并接受微创手术治疗的235例单侧复发性静脉曲张患者的临床资料。男性112例,女性123例,年龄(62.5±11.4)岁(范围:24~75岁),按照影像学检查方法将患者分为三维CT静脉造影(CTV)组(检查方法为下肢静脉超声+CTV)和对照组(检查方法为下肢静脉超声+静脉顺行造影),采用倾向性评分匹配法对两组患者进行1∶1匹配,匹配后CTV组和对照组均43例。采用独立样本t检验、Willcoxon秩和检验、χ^(2)检验、线性回归分析等方法比较匹配后两组患者术后1年的随访情况。结果术后1年,CTV组患者的静脉疾病严重程度评分(VCSS)低于对照组[M(IQR),3.0(4.3)分比4.0(5.8)分,Z=-2.038,P=0.040],慢性静脉功能不全患者生活质量问卷(CIVIQ-20)评分高于对照组[89.0(8.0)分比 82.5(17.0)分,Z=-2.627,P=0.010]。CTV组患者溃疡愈合时间短于对照组[4.0(4.0)周比12.0(7.0)周,Z=-3.217,P<0.01]。两组均未出现临床症状性复发性静脉曲张或溃疡,但均有超声检测性静脉曲张复发,差异无统计学意义(χ^(2)=0.453,P=0.500)。CTV在超声基础上补充发现需要处理的血管病变16例次,顺行静脉造影补充发现7例次,差异有统计学意义(χ^(2)=4.800,P=0.030)。线性回归分析结果显示,临床表现-病因学-解剖学-病理生理学临床分级、术前影像学检查方法为患者术后1年VCSS和CIVIQ-20评分的独立影响因素。结论对于复发性静脉曲张患者,CTV辅助超声可直接、全面地评估和定位病变静脉,下肢静脉超声结合下肢血管CTV指导下的微创手术治疗可明显改善患者治疗效果,优于顺行静脉造影评估。Objective To compare the efficacy of lower extremity three dimensional CT venography(CTV)and lower extremity ascending phlebography in evaluating recurrent varicose veins.Methods A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University,between January 2015 and December 2020.There were 112 males and 123 females,with an age of(62.5±11.4)years(range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group(utilizing lower extremity venous ultrasound+lower extremity CTV)and the control group(employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching,resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests,Wilcoxon rank-sum tests,χ^(2) tests,and linear regression analysis.Results One year post-surgery,the CTV group exhibited a lower venous clinical severity score(VCSS)compared to the control group(M(IQR),3.0(4.3)vs.4.0(5.8),Z=-2.038,P=0.040).Additionally,the chronic venous insufficiency patients′quality of life questionnaire(CIVIQ-20)scores were significantly higher in the CTV group than in the control group(89.0(8.0)vs.82.5(17.0),Z=-2.627,P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group(4.0(4.0)weeks vs.12.0(7.0)weeks,Z=-3.217,P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However,they exhibited ultrasound-detectable varicose vein recurrence,with no statistically significant difference(χ^(2)=0.453,P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16,while the number supplemented by ascending phlebography was 7,with a statistically signific

关 键 词：静脉曲张 静脉造影术 体层摄影术 外科手术 微创性 

分 类 号：R654.3[医药卫生—外科学]