存在下肢静脉功能不全时卵巢静脉功能不全的患病率及管理

Sutaria R, Subramanian A, Burns B, Hafez H

St. Richard's Hospital, Chichester, West Sussex, UK.

Phlebology. 2007;22(1):29-33. doi: 10.1258/026835507779700617.

OBJECTIVE

The correlation between ovarian venous insufficiency and lower limb venous insufficiency remains poorly understood. Clinically, incompetent ovarian veins in association with lower extremity varicose veins are suspected when leg varicose veins are found in atypical distributions. Such distributions include upper lateral or posterior thigh, on the buttocks, crossing the inguinal ligament, and also in the vulval or perineal regions. The aim of this study was to determine the prevalence of ovarian venous insufficiency in those with clinically suspicious varicose veins, and to assess the effectiveness of ovarian venous embolization/ligation in treating this condition.

METHODS

Between June 2001 and December 2004, 424 female patients with lower limb superficial venous insufficiency were seen by a single vascular surgeon. These patients were clinically assessed, and those with atypical varicose veins were investigated with venous duplex examination and magnetic resonance imaging (MRI) venography. Patients with proven ovarian venous insufficiency were offered venography with a view to embolization or laparoscopic ligation.

RESULTS

A total of seven patients were clinically suspected of having ovarian venous insufficiency, of which three had recurrent varicose veins (42.9%). Of these, six were confirmed on MRI venography with the left side being more affected than the right; one of them had an occluded vena cava, three were treated by embolization, and two had laparoscopic ligation.

DISCUSSION

The prevalence of clinically detectable ovarian venous insufficiency in association with lower extremity varicose veins is in the region of 1.65%. Compared with the estimated prevalence of incidental ovarian venous insufficiency of 10-47%, this suggests that only a minority of incompetent ovarian veins will present with clinically detectable lower limb venous insufficiency. In our opinion, patients with signs suggestive of ovarian venous insufficiency in association with lower limb venous insufficiency should have their ovarian insufficiency controlled prior to embarking on limb venous surgery.

目的

卵巢静脉功能不全与下肢静脉功能不全之间的相关性仍未得到充分了解。临床上，当发现腿部静脉曲张分布不典型时，怀疑存在与下肢静脉曲张相关的卵巢静脉功能不全。这些不典型分布包括大腿上外侧或后侧、臀部、穿过腹股沟韧带，以及外阴或会阴区域。本研究的目的是确定临床可疑静脉曲张患者中卵巢静脉功能不全的患病率，并评估卵巢静脉栓塞/结扎治疗这种情况的有效性。

方法

2001年6月至2004年12月期间，一名血管外科医生诊治了424例下肢浅静脉功能不全的女性患者。对这些患者进行了临床评估，对不典型静脉曲张患者进行了静脉双功超声检查和磁共振成像（MRI）静脉造影。确诊为卵巢静脉功能不全的患者接受了静脉造影，以期进行栓塞或腹腔镜结扎。

结果

共有7例患者临床怀疑有卵巢静脉功能不全，其中3例有复发性静脉曲张（42.9%）。其中，6例经MRI静脉造影确诊，左侧比右侧受累更严重；其中1例有腔静脉闭塞，3例接受栓塞治疗，2例接受腹腔镜结扎。

讨论

与下肢静脉曲张相关的临床可检测到的卵巢静脉功能不全的患病率约为1.65%。与偶然发现的卵巢静脉功能不全估计患病率10%-47%相比，这表明只有少数功能不全的卵巢静脉会出现临床可检测到的下肢静脉功能不全。我们认为，伴有下肢静脉功能不全且有卵巢静脉功能不全迹象的患者，在进行肢体静脉手术之前应先控制卵巢功能不全。