下肢静脉造影对于下肢浅表静脉曲张、Cockett综合征诊断意义的临床研究

发布时间：2018-03-11 13:38

本文选题：下肢浅表静脉曲张　切入点：Cockett　出处：《青海大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:调查下肢浅表静脉曲张(LVSV)病人中Cockett综合征的患病率;以造影作为诊断Cockett综合征、明确LVSV手术禁忌症的标准,调查彩超检查的准确性、敏感性、漏诊率;调查两种不同的检查方法手术率、禁忌症的构成和术后深静脉血栓形成(DVT)的发生率,评估LVSV、Cockett综合征人应用静脉血管造影的临床价值。方法:收集2016年1月1日至2016年12月31日收住的LVSV病人115人,以造影作为诊断Cockett综合征为标准,调查其Cockett综合征的患病率,并调查彩超检查的敏感性、漏诊率;收集青海大学附属医院心胸外科2014年10月1日至2016年10月31日收住的LVSV病人193例。根据检查方法不同,分为A(单纯彩超组)59人,B(彩超+造影组)134人两组,调查两组的手术率、禁忌症构成。对于接受经典下肢主干高位结扎+曲张静脉剥脱术,术后应用低分子肝素钙,记录患者院外(随访时间为3个月-1年)是否出现DVT,其结果运用统计学软件处理、分析对LVSV术后发生DVT的影响;B组接受了血管彩超+造影检查的患者共134名,检查结果以造影为准,判别彩超检查针对LVSV手术各种禁忌症的准确性、敏感性、漏诊率。结果:(1)2016年1月1日至2016年12月31日LVSV共115例,静脉造影诊断Cockett综合征15例,患病率约为13.0%,彩超结果约为1.7%;以造影作为诊断Cockett综合征为标准,彩超敏感度(Se)=13.3%,漏诊率(β)=86.7%。(2)2014年10月1日至2016年10月31日共134名行彩超+造影病例,以造影作为明确LVSV手术禁忌症的标准,彩超判定LVSV病人深静脉瓣膜功能不全准确率=91.5%;判定LVSV深静脉血栓形成准确率=100%;判定LVSV中Cockett综合征准确率=29%。(3)2014年10月1日至2016年10月31日共193名LVSV病人,患肢、性别、分级、病史、发病年龄等统计学分析结果P0.05,差异无统计学意义。A组手术率72.9%,术后DVT 8人(男性3人,女性5人),发生率18.6%;B组手术率58.2%,术后DVT 4人(男性2人,女性2人),发生率5.1%,χ2=4.23,P=0.040.05,差异结果有意义。(4)A、B两组手术禁忌症的构成中,深静脉瓣膜功能不全均为第一位,χ2=1.93,P0.05,结果有意义。结论(1)我科室2016年度下肢浅表静脉曲张患者中,造影诊断Cockett综合征的患病率,结果约为13.0%,血管彩超敏感度低,漏诊率高,不能取代造影的诊断地位;(2)静脉造影术对于LVSV手术指征筛查效能高,因而可能减少术后患肢DVT;(3)血管彩超不能取代造影对LVSV诊断的临床地位,但是可以作为初筛手段。(4)针对LVSV患者,选择性应用彩超,造影,价值更高。
[Abstract]:Objective: to investigate the prevalence of Cockett syndrome in patients with superficial varicose vein of lower extremity, to make sure the standard of contraindication of LVSV operation, to investigate the accuracy, sensitivity and missed diagnosis rate of color Doppler ultrasonography (CDFI) in diagnosing Cockett syndrome. To investigate the operative rate of two different examination methods, the constitution of contraindication and the incidence of DVT after operation. Objective: to evaluate the clinical value of intravenous angiography in patients with LVSV syndrome from January 1st 2016 to December 31st 2016. Methods: to investigate the prevalence of Cockett syndrome in patients with Cockett syndrome. The sensitivity and missed diagnosis rate of color Doppler ultrasonography were investigated, and 193 LVSV patients admitted from October 1st 2014 to October 31st 2016 in Cardiopulmonary surgery, affiliated Hospital of Qinghai University, were collected. The patients were divided into A group (A group, n = 59) and B group (group B, n = 134). The operative rate and contraindications of the two groups were investigated, and low molecular weight heparin calcium was used after the operation of varicose vein exfoliation with high ligation of the main trunk of the lower extremity. DVTs were recorded out of hospital (follow-up time from 3 months to 1 year). The results were analyzed with statistical software to analyze the influence of DVT after LVSV in group B (134 patients received angiography by color Doppler angiography). The accuracy, sensitivity and missed diagnosis rate of color Doppler ultrasonography for various contraindications of LVSV surgery were determined. Results: from January 1st 2016 to December 31st 2016, 115 cases of LVSV were diagnosed by venography, and 15 cases of Cockett syndrome were diagnosed by venography. The prevalence rate was about 13.0 and the result of color ultrasound was about 1.7.The color Doppler ultrasound sensitivity was 13.33.The missed diagnosis rate was 86.7% from October 1st 2014 to October 2016. From October 1st 2014 to October 2016, 134 patients underwent color Doppler imaging. Contrast examination was used as the standard for determining contraindications of LVSV surgery. The accuracy of color Doppler ultrasound in determining deep venous valve insufficiency in patients with LVSV was 91.5%; in determining the accuracy rate of deep venous thrombosis in LVSV was 100; and in determining the accuracy of Cockett syndrome in LVSV 29.3%) from October 1st 2014 to October 2016, there were 193 LVSV patients, including limbs, sex, classification, and history. There was no significant difference in the operative rate between group A and group A (P 0.05). There were 8 patients (3 males and 5 females) with postoperative DVT (3 males, 5 females), the incidence rate was 58.2% in group B, 4 patients (2 males) with DVT after operation. The incidence rate of two female patients was 5.1 and 蠂 2 4.23% P0.040.05. The difference was significant. In the contraindication of operation, deep venous valve insufficiency was the first, 蠂 2 = 1.93, P 0.05, the results were significant. Conclusion 1) in our department, the patients with superficial venous varices of lower extremity in 2016 were all the first. The prevalence of angiographic diagnosis of Cockett syndrome is about 13.0. The sensitivity of color Doppler ultrasound is low and the rate of missed diagnosis is high. It can not replace the diagnostic status of angiography. Therefore, it may be possible to reduce the value of color Doppler ultrasound in the diagnosis of LVSV, but it can be used as a primary screening method for LVSV patients. The selective use of color Doppler ultrasound and angiography is more valuable.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.4

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