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目的应用多层螺旋 CT 血管成像(CTA),探讨髂总静脉汇合部的解剖与髂静脉压迫综合征的关系。方法对无下肢血管闭塞性病变主诉和体征的80例患者行多层螺旋 CT 腹部增强扫描,采用多平面重组显示髂总静脉汇合部,测量右髂总动脉跨越处左髂总静脉前后径、两侧髂总静脉汇入下腔静脉的角度、横断面及正交断面上两侧髂总静脉的内径和面积,并对测量结果进行统计分析。结果横断面上两侧髂总静脉的平均内径、面积及其比值[右、左侧内径分别为(14.8±2.7)、(19.1±5.3)mm,面积分别为(171±61)、(244±112)mm~2,与下腔静脉内径比分别为0.79±0.12和1.03±0.30,与下腔静脉面积比分别为0.65±0.20和0.93±0.47]均大于正交断面[右、左侧内径分别为(14.1±2.3)、(15.6±3.5)mm,面积分别为(157±51)、(182±74)mm~2,与下腔静脉内径比分别为0.75±0.10和0.83±0.16,与下腔静脉面积比分别为0.59±0.19和0.68±0.25]相应数值(t=3.525～7.979,P 均<0.01)。正交断面左侧髂总静脉与下腔静脉内径比和面积比均大于右侧(t 值分别为13.030和10.942,P 均<0.01)。右侧髂总静脉汇入下腔静脉的夹角小于左侧(P<0.01)。在非老年(年龄<65岁)患者中,男性在右髂总动脉跨越处测量的左髂总静脉前后径及正交断面上的面积[分别为(9.2±3.5)mm和(209±63)mm~2]大于女性[分别为(6.0±3.1)mm 和(150±74)mm~2](t 值分别为3.120和2.880,P<0.01)。在老年(年龄t≥65岁)患者中,男性左髂总静脉正交断面面积及其与下腔静脉面积的比值[分别为(207±90)mm~2和(0.80±0.34)]大于女性[分别为(138±38)mm~2和(0.59±0.14)](t 值分别为2.811和2.245,P<0.05)。结论 CTA 能多平面显示髂总静脉汇合部的解剖,并可进行多方位准确测量,对髂静脉压迫综合征的诊断有临床应用价值。
Objective To evaluate the relationship between the anatomy of iliac vein confluence and iliac vein compression syndrome by multi-slice spiral CT angiography (CTA). Methods Eighty patients with vaso-occlusive lesions of lower extremities were examined by multi-slice helical CT abdomen enhanced scan. The common iliac vein confluence was displayed by multiplanar reconstruction. The anteroposterior diameter of common left common iliac vein Side of the common iliac vein into the inferior vena cava angle, cross-section and the cross section of both sides of the common iliac vein diameter and area, and the results of the statistical analysis. Results The average diameter, area and ratio of the common iliac vein on both sides of the cross section were (14.8 ± 2.7) and (19.1 ± 5.3) mm in the right and left sides, respectively (171 ± 61 and 244 ± 112) mm ~ 2, and the IVC ratio of inferior vena cava were 0.79 ± 0.12 and 1.03 ± 0.30, respectively, and the areas of inferior vena cava were 0.65 ± 0.20 and 0.93 ± 0.47, respectively Were (14.1 ± 2.3) and (15.6 ± 3.5) mm respectively, and the areas were (157 ± 51) and (182 ± 74) mm ~ 2 respectively. The ratios of IVD to inferior vena cava were 0.75 ± 0.10 and 0.83 ± 0.16, The ratio of vena caval area was 0.59 ± 0.19 and 0.68 ± 0.25 respectively (t = 3.525-7.979, P <0.01). The diameter ratio and the area ratio of left common iliac vein to inferior vena cava in the orthogonal section were greater than those in the right side (t = 13.030 and 10.942, respectively, P <0.01). The right common iliac vein into the inferior vena cava angle less than the left (P <0.01). In non-elderly patients (<65 years of age), the anteroposterior diameter of the common left common iliac artery measured at the right common iliac artery in the male and the area on the orthogonal cross-section were (9.2 ± 3.5) mm and (209 ± 63) mm ~ 2] were significantly greater in women than in women [(6.0 ± 3.1) mm and (150 ± 74) mm ~ 2 respectively] (t = 3.120 and 2.880, respectively; P <0.01). In elderly (age ≥65 years) patients, the ratio of the orthogonal cross-sectional area of the left common iliac vein to the area of the inferior vena cava in men (207 ± 90 mm 2 and 0.80 ± 0.34, respectively) [(138 ± 38) mm ~ 2 and (0.59 ± 0.14)], respectively (t = 2.811 and 2.245, respectively, P <0.05). Conclusion CTA can display the anatomy of the confluence of the common iliac vein with multiplanar images and can be accurately measured in many directions. It has clinical value in the diagnosis of iliac vein compression syndrome.