發(fā)布時(shí)間：2018-03-11 13:38

  本文選題：下肢淺表靜脈曲張　切入點(diǎn)：Cockett　出處：《青海大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:調(diào)查下肢淺表靜脈曲張(LVSV)病人中Cockett綜合征的患病率;以造影作為診斷Cockett綜合征、明確LVSV手術(shù)禁忌癥的標(biāo)準(zhǔn),調(diào)查彩超檢查的準(zhǔn)確性、敏感性、漏診率;調(diào)查兩種不同的檢查方法手術(shù)率、禁忌癥的構(gòu)成和術(shù)后深靜脈血栓形成(DVT)的發(fā)生率,評(píng)估LVSV、Cockett綜合征人應(yīng)用靜脈血管造影的臨床價(jià)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,以造影作為診斷Cockett綜合征為標(biāo)準(zhǔn),調(diào)查其Cockett綜合征的患病率,并調(diào)查彩超檢查的敏感性、漏診率;收集青海大學(xué)附屬醫(yī)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。根據(jù)檢查方法不同,分為A(單純彩超組)59人,B(彩超+造影組)134人兩組,調(diào)查兩組的手術(shù)率、禁忌癥構(gòu)成。對(duì)于接受經(jīng)典下肢主干高位結(jié)扎+曲張靜脈剝脫術(shù),術(shù)后應(yīng)用低分子肝素鈣,記錄患者院外(隨訪時(shí)間為3個(gè)月-1年)是否出現(xiàn)DVT,其結(jié)果運(yùn)用統(tǒng)計(jì)學(xué)軟件處理、分析對(duì)LVSV術(shù)后發(fā)生DVT的影響;B組接受了血管彩超+造影檢查的患者共134名,檢查結(jié)果以造影為準(zhǔn),判別彩超檢查針對(duì)LVSV手術(shù)各種禁忌癥的準(zhǔn)確性、敏感性、漏診率。結(jié)果:(1)2016年1月1日至2016年12月31日LVSV共115例,靜脈造影診斷Cockett綜合征15例,患病率約為13.0%,彩超結(jié)果約為1.7%;以造影作為診斷Cockett綜合征為標(biāo)準(zhǔn),彩超敏感度(Se)=13.3%,漏診率(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,以造影作為明確LVSV手術(shù)禁忌癥的標(biāo)準(zhǔn),彩超判定LVSV病人深靜脈瓣膜功能不全準(zhǔn)確率=91.5%;判定LVSV深靜脈血栓形成準(zhǔn)確率=100%;判定LVSV中Cockett綜合征準(zhǔn)確率=29%。(3)2014年10月1日至2016年10月31日共193名LVSV病人,患肢、性別、分級(jí)、病史、發(fā)病年齡等統(tǒng)計(jì)學(xué)分析結(jié)果P0.05,差異無統(tǒng)計(jì)學(xué)意義。A組手術(shù)率72.9%,術(shù)后DVT 8人(男性3人,女性5人),發(fā)生率18.6%;B組手術(shù)率58.2%,術(shù)后DVT 4人(男性2人,女性2人),發(fā)生率5.1%,χ2=4.23,P=0.040.05,差異結(jié)果有意義。(4)A、B兩組手術(shù)禁忌癥的構(gòu)成中,深靜脈瓣膜功能不全均為第一位,χ2=1.93,P0.05,結(jié)果有意義。結(jié)論(1)我科室2016年度下肢淺表靜脈曲張患者中,造影診斷Cockett綜合征的患病率,結(jié)果約為13.0%,血管彩超敏感度低,漏診率高,不能取代造影的診斷地位;(2)靜脈造影術(shù)對(duì)于LVSV手術(shù)指征篩查效能高,因而可能減少術(shù)后患肢DVT;(3)血管彩超不能取代造影對(duì)LVSV診斷的臨床地位,但是可以作為初篩手段。(4)針對(duì)LVSV患者,選擇性應(yīng)用彩超,造影,價(jià)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.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.4

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