您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (11): 47-51.doi: 10.6040/j.issn.1671-7554.0.2019.542

• • 上一篇    

85例复发性下肢静脉曲张影像学检查相关分析

吴梦涛1,郭亚南1,唐佃俊1,王素珍2,周涛1,李凡东1   

  1. 1.山东大学第二医院血管外科, 山东 济南 250033;2.青岛大学附属医院肝脏移植科, 山东 青岛 266003
  • 发布日期:2022-09-27
  • 通讯作者: 李凡东. E-mail:fandongli90@hotmail.com
  • 基金资助:
    山东省医药卫生科技发展计划(2017WS627);山东大学临床医学院、齐鲁医学院教学改革项目(LCJY-65;qlyxjy-201949)

An analysis of the imaging information of 85 patients with recurrent varicose veins in lower extremity

WU Mengtao1, GUO Yanan1, TANG Dianjun1, WANG Suzhen2, ZHOU Tao1, LI Fandong1   

  1. 1. Department of Vascular Surgery, The Second Hospital of Shandong University, Jinan 250033, Shandong, China;
    2. Department of Liver Transplantation, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
  • Published:2022-09-27

PDF (PC)

9

摘要： 目的 探讨与复发性下肢静脉曲张有关联的危险因素。 方法 基于血流动力学回顾性分析山东大学第二医院2013年6月至2018年6月收治复发性下肢静脉曲张患者85例(85条肢体)的临床资料。根据彩色多普勒超声和CT影像学检查结果,分析病例的复发原因。以临床表现-病因学-解剖-病理生理静脉分类系统(clinical, etiological, anatomical, pathophysiological classification, CEAP)的临床分级作为应变量,应用有序Logistic回归,分析应变量与复发原因的相互关系,探讨下肢静脉曲张术后复发的相关危险因素。 结果 85例患者中大隐静脉主干与属支的残留或再通者占37.6%,静脉管腔狭窄或阻塞者占30.6%,穿通静脉功能不全者占23.5%,小隐静脉功能不全者占8.2%。通过Logistic回归分析,穿通静脉功能不全(OR=10.465,95%CI:2.980~36.782,P<0.001)、深静脉系统狭窄(OR=9.554,95%CI: 2.933~31.094,P<0.001)、复发时间(OR=1.684,95%CI:1.335~2.123,P<0.001)以及年龄(OR=0.930,95%CI:0.877~0.985,P=0.014)对复发性下肢静脉曲张的CEAP临床分级的影响差异有统计学意义;而性别(OR=1.068,95%CI:0.439~2.596,P=0.885)和大隐静脉主干残留(OR=0.758,95%CI:0.239~2.406,P=0.638)对复发性下肢静脉曲张的CEAP临床分级差异无统计学意义。 结论 穿通静脉功能不全、深静脉系统狭窄和复发时间是复发性下肢静脉曲张的独立危险因素;年龄因素是复发性下肢静脉曲张的保护因素。

关键词: 静脉曲张, 复发, 血流动力学, 危险因素, 穿通静脉

Abstract: Objective To investigate the risk factors of recurrent varicose veins in lower extremity. Methods The hemodynamic data of 85 patients(85 limbs)with recurrent varicose veins in lower extremity treated during June 2013 and June 2018 were retrospectively analyzed. The color Doppler ultrasound and CT imaging results were analyzed to investigate the causes of recurrence. The classification in clinical, etiological, anatomical, pathophysiological classification(CEAP)was used as the dependent variable. The relationship between the dependent variable and causes of recurrence was analyzed with ordinal logistic regression, and the risk factors of recurrence were explored. Results In 85 patients, 37.6% had residual or recanalization of the great saphenous vein and its branches, 30.6% had venous stenosis or obstruction, 23.5% had penetrating venous insufficiency, and 8.2% had small saphenous vein insufficiency. Logistic regression analysis showed that penetrating venous insufficiency(OR=10.465, 95%CI: 2.980-36.782, P<0.001), deep 山 东 大 学 学 报 (医 学 版)57卷11期 -吴梦涛,等.85例复发性下肢静脉曲张影像学检查相关分析 \=-venous system stenosis(OR=9.554, 95%CI: 2.933-31.094, P<0.001), recurrence time(OR=1.684, 95%CI: 1.335-2.123, P<0.001)and age(OR=0.930, 95%CI: 0.877-0.985, P=0.014)had statistically significant effects on the CEAP classification of recurrent varices, while gender(OR=1.068, 95%CI: 0.439-2.596, P=0.885)and residual great saphenous vein(OR=0.758, 95%CI: 0.239-2.406, P=0.638)had no significant effects. Conclusion Perforating venous insufficiency, deep venous stenosis and recurrence time are independent risk factors while age is a protective factor for recurrent lower extremity varices.

Key words: Varicose veins, Recurrent, Hemodynamics, Risk factors, Perforating vein

中图分类号: 

  • R543.6
[1] Brake M, Lim CS, Shepherd AC, et al. Pathogenesis and etiology of recurrent varicose veins[J]. J Vasc Surg, 2013, 57(3): 860-868.
[2] van Neer P, Kessels FG, Estourgie RJ, et al. Persistent reflux below the knee after stripping of the great saphenous vein[J]. J Vasc Surg, 2009, 50(4): 831-834.
[3] Recek C. Venous pressure gradients in the lower extremity and the hemodynamic consequences [J]. Vasa, 2010, 39(4): 292-297.
[4] Pittaluga P, Chastanet S, Guex JJ. Great saphenous vein stripping with preservation of sapheno-femoral confluence: hemodynamic and clinical results [J]. J Vasc Surg, 2008, 47(6): 1300-1304.
[5] 吴庆华, 张煜亚. 推广普及CEAP分级法在我国血管外科的临床应用[J]. 中华普通外科杂志, 2008, 23(3): 164-167.
[6] 李传勇, 孙蓬, 沈超, 等. 分析81例下肢静脉曲张术后复发原因[J]. 国际外科学杂志, 2017, 44(11): 753-756. LI Chuanyong, SUN Peng, SHEN Chao, et al. Analysis of postoperative recurrence of varicose veins of lower extremity in 81 cases [J]. International Journal of Surgery, 2017,44(11): 753-756.
[7] 黎洪浩, 曹海玲, 陈建宇, 等. 下肢静脉曲张术后复发的原因分析(附46例报告)[J]. 中国实用外科杂志,2006,26(2): 133-135. LI Honghao, CAO Hailing, CHEN Jianyu, et al. Causes of the recurrence of varicose veins after varicotomy in lower extremity [J]. Chinese Journal of Practical Surgery, 2006, 26(2): 133-135.
[8] Rasmussen L, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years[J]. J Vasc Surg, 2013, 58(2):421-426.
[9] Uema RT, Dezotti NR, Joviliano EE, et al. A prospective study of venous hemodynamics and quality of live at least five years after varicose vein stripping [J]. Acta Cir Bras, 2013, 28(11): 794-799.
[10] Raffetto JD. Pathophysiology of chronic venous disease and venous ulcers [J]. Surg Clin North Am, 2018, 98(2): 337-347.
[11] Hamann S, Giang J, De Maeseneer M, et al. Editors choice-five year results of great saphenous vein treatment: a meta-analysis [J]. Eur J Vasc Endovasc Surg, 2017, 54(6): 760-770.
[12] Lawaetz M, Serup J, Lawaetz B, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT [J]. Int Angiol, 2017, 36(3): 281-288.
[13] Cheatle T. The long saphenous vein: to strip or not to strip [J]. Semin Vasc Surg, 2005, 18(1): 10-14.
[14] Pittaluga P, Chastanet S. Persistent incompetent truncal veins should not be treated immediately [J]. Phlebology, 2015, 30(1 Suppl): 98-106.
[15] Milone M, Salvatore G, Maietta P, et al. Recurrent varicose veins of the lower limbs after surgery. Role of surgical technique(stripping vs. CHIVA)and surgeons experience [J]. G Chir, 2011, 32(11-12): 460-463.
[16] Gianesini S, Occhionorelli S, Menegatti E, et al. CHIVA strategy in chronic venous disease treatment: instructions for users [J]. Phlebology, 2015, 30(3): 157-171.
[17] Yun S. Ultrasound-based topographic analysis of tributary vein connection with the saphenous vein during ambulatory conservative hemodynamic correction of chronic venous insufficiency [J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(3): 356-363.
[18] Zmudzinski M, Malo P, Hall C, et al. CHIVA-A prospective study of a vein sparing technique for the management of varicose vein disease [J]. Am J Surg, 2017, 213(5): 967-969.
[19] Rutherford EE, Kianifard B, Cook SJ, et al. Incompetent perforating veins are associated with recurrent varicose veins [J]. Eur J Vasc Endovasc Surg, 2001, 21(5): 458-460.
[20] Eidson JL, Bush RL. Diagnosis and current management of incompetent perforator veins [J]. Semin Vasc Surg, 2010, 23(2): 113-117.
[21] Dillavou ED, Harlander-Locke M, Labropoulos N, et al. Current state of the treatment of perforating veins [J]. J Vasc Surg Venous Lymphat Disord, 2016, 4(1): 131-135.
[22] Darke SG. Incompetent perforating vein ligation in the treatment of venous ulceration [J]. Ann R Coll Surg Engl, 1987, 69(1): 43.
[23] Lin L, Tang J, Huang Z, et al. Studies on the relationship between perforating vein insufficiency and iliac compression syndrome [J]. J Clin Lab Anal, 2018, 32(8): 22577.
[24] Vazquez SR, Kahn SR. Advances in the diagnosis and management of postthrombotic syndrome [J]. Best Pract Res Clin Haematol, 2012, 25(3): 391-402.
[25] Galanaud JP, Bertoletti L, Amitrano M, et al. Predictors of post-thrombotic ulcer after acute DVT: the RIETE registry [J]. Thromb Haemost, 2018, 118(2): 320-328.
[26] Hernández-Gea V, Gottardi A, Leebeek F, et al. Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis [J]. J Hepatol, 2019, 71(1):175-199.
[27] Liu P, Peng J, Zheng L, et al. Application of computed tomography venography in the diagnosis and severity assessment of iliac vein compression syndrome: A retrospective study [J]. Medicine(Baltimore), 2018, 97(34): 12002.
[1] 张小艳 李刚 王令平. 不同剂量舒芬太尼对脊柱手术患者全麻诱导期血流动力学及血浆皮质醇的影响[J]. 山东大学学报(医学版), 2209, 47(6): 76-79.
[2] 张莹 王宏伟 王慧 陈福琴. Graves病复发患者外周血中转化生长因子β1水平的变化[J]. 山东大学学报(医学版), 2209, 47(6): 80-.
[3] 姚雪,卢冉冉,孙淑玲,高翠平,肖茹,王书会. 风湿性心脏病患者瓣膜置换术后医院感染风险预测评分模型的构建[J]. 山东大学学报 (医学版), 2022, 60(6): 90-96.
[4] 杨丛品,罗卓野,许秀华,李爱民,郝桂敏. 河北省某医院体检3 512例育龄女性生育选择及压力现状[J]. 山东大学学报 (医学版), 2022, 60(4): 62-67.
[5] 左立平,蒋丰洋,周斌彬,范金蕾,梁永锋,邓展昊,于德新. 术前MRI在预测169例肝细胞肝癌微血管侵犯及早期复发的价值[J]. 山东大学学报 (医学版), 2022, 60(3): 89-95.
[6] 吕岩红,张志勉. 2 809名体检人群中高血压与幽门螺杆菌感染的关联性[J]. 山东大学学报 (医学版), 2022, 60(2): 43-47.
[7] 国云飞,舒强. 免疫抑制剂在风湿病相关复发性流产中的应用[J]. 山东大学学报 (医学版), 2021, 59(8): 38-43.
[8] 赵冰清,高选,李江夏. 基于辅助生殖人群的复发性流产夫妇染色体核型回顾性分析[J]. 山东大学学报 (医学版), 2021, 59(7): 26-31.
[9] 陈丽宇,肖娟,吕仙忠,段宝敏,洪凡真. 影响孕产妇下肢深静脉血栓预后的危险因素分析[J]. 山东大学学报 (医学版), 2021, 59(7): 38-42.
[10] 司海朋,张文灿,李乐,周鑫. Kümmell's病的危险因素和诊治研究进展[J]. 山东大学学报 (医学版), 2021, 59(6): 25-32.
[11] 兰洪涛,贾旭,童洲杰,郑曼,胡伯昂,钟明,张薇,王志浩. 无选择性152例成年慢性心力衰竭患者再入院的危险因素[J]. 山东大学学报 (医学版), 2021, 59(4): 63-69.
[12] 谢同辉,陈志强,常建华,赵丹文,徐博文,智绪亭. 肝内胆管癌根治性切除术后生存因素分析及列线图的建立[J]. 山东大学学报 (医学版), 2021, 59(4): 93-99.
[13] 宋珍珍,孙小玲,李海鸥,王芳,张冉,于德新. 120例胶质瘤及瘤周水肿MRI影像组学在评估肿瘤复发中的价值[J]. 山东大学学报 (医学版), 2021, 59(11): 53-60.
[14] 王纬,王凤琴,韩艳丽. 腹腔镜下右附件囊肿剥除术后发生心脏骤停1例[J]. 山东大学学报 (医学版), 2021, 59(11): 123-124.
[15] 孙胜房,马会力,贾竹亭,李民涛. 车祸所致880例四肢开放性损伤并发早期感染的危险性因素分析[J]. 山东大学学报 (医学版), 2021, 59(1): 72-77.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发