85例复发性下肢静脉曲张影像学检查相关分析

doi:10.6040/j.issn.1671-7554.0.2019.542

摘要/Abstract

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

吴梦涛,郭亚南,唐佃俊,王素珍,周涛,李凡东. 85例复发性下肢静脉曲张影像学检查相关分析[J]. 山东大学学报 (医学版), 2019, 57(11): 47-51.

WU Mengtao, GUO Yanan, TANG Dianjun, WANG Suzhen, ZHOU Tao, LI Fandong. An analysis of the imaging information of 85 patients with recurrent varicose veins in lower extremity[J]. Journal of Shandong University (Health Sciences), 2019, 57(11): 47-51.

参考文献

[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.

相关文章 15

[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]	黄玉真,吕琛,颜磊,李帅帅,张景雪,刘超,王银霞,桑岩岩,房鹛. 基于危险因素筛查的延续性院外管理对卵巢过度刺激综合征的预防效果[J]. 山东大学学报 (医学版), 2026, 64(4): 92-99.
[4]	逄锦宏,苏萍,乔俊鹏,陈巧巧,陈学禹,赵颖颖,施婕,孙晓茹,李秋春,何蕊言,范轶欧,迟蔚蔚. 老年人群可改变心血管危险因素聚集模式与脑卒中的关联[J]. 山东大学学报 (医学版), 2025, 63(9): 11-19.
[5]	张政,王建伟,杨玉娟,张宇,宋西成. 哮喘儿童2008及2019年免疫球蛋白E变化及相关危险因素[J]. 山东大学学报 (医学版), 2025, 63(7): 32-36.
[6]	万文静,高姗姗. 低分子肝素在生殖领域的应用[J]. 山东大学学报 (医学版), 2025, 63(6): 117-124.
[7]	李敬,郝盼盼. 急性心力衰竭患者出入院心率变化与预后相关性[J]. 山东大学学报 (医学版), 2025, 63(4): 75-82.
[8]	杨卫芳,徐宏,刘元涛,赵蕙琛. 促甲状腺激素受体抗体在Graves病复发中的作用机制及其临床意义[J]. 山东大学学报 (医学版), 2025, 63(4): 116-121.
[9]	程震宇,来庆国,吴梦涛. 髂股静脉支架置入术后再狭窄的影响因素研究进展[J]. 山东大学学报 (医学版), 2025, 63(12): 112-117.
[10]	程跃启,王斐,于理想,郑超,余之刚. 曲妥珠单抗致HER2阳性乳腺癌患者心脏毒性的研究进展[J]. 山东大学学报 (医学版), 2025, 63(1): 17-24.
[11]	王浙宇,许懿,赵昌波,杨硕菲,倪其泓,陈佳佺,王韦仑,李一男,郭相江,叶猛,张岚,薛冠华. 腹主动脉瘤腔内修复术后发生髂支闭塞的危险因素及处理对策[J]. 山东大学学报 (医学版), 2024, 62(9): 101-107.
[12]	郭鑫,孟君,郑世良,董秀红. 老年胃癌患者衰弱与人体成分的相关性[J]. 山东大学学报 (医学版), 2024, 62(4): 40-47.
[13]	李建,孙云. 新入维持性血液透析患者2年内死亡的危险因素[J]. 山东大学学报 (医学版), 2024, 62(4): 48-53.
[14]	石军,牛子捷,王军,马丽晶,奚春花,肖洋. 幼年型复发性呼吸道乳头状瘤病肺部播散的临床特点及麻醉要点[J]. 山东大学学报 (医学版), 2024, 62(12): 82-89.
[15]	宋甜田,李作坤,王书会. 个体化预测老年心脏瓣膜置换术后医院感染风险Nomogram模型的构建[J]. 山东大学学报 (医学版), 2024, 62(1): 48-56.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed