Division of Hospital Medicine, Department of Medicine, 4530University of Kentucky, Lexington, USA.
Phlebology. 2021 Aug;36(7):535-540. doi: 10.1177/0268355521994985. Epub 2021 Feb 14.
Deep venous thrombosis (DVT) is known to occur preferentially on the left lower extremity. The renowned surgeon Denis Burkitt advanced the theory that a heavy sigmoid colon would compress the left pelvic veins and predispose to DVT. Our study aimed to evaluate this hypothesis by comparing the laterality distributions with and without a prior colectomy.
We conducted a retrospective analysis of the 2016 National Inpatient Sample database by stratifying the patients at any age with acute DVT of lower extremity by history of prior colectomy, thereby eliminating local gut mechanical factors in the development of DVT. We compared the laterality distribution (i.e., left, right, bilateral, and unspecified) between the patients with and without a prior colectomy. We also conducted a subgroup analysis by the sex category to examine the difference in laterality distribution for male and female patients. Chi-square test for independence was used. P value ≤0.05 was considered statistically significant.
We found an estimated total of 342,525 cases. Among patients without a prior colectomy, 136,605 (41.6%) were left-sided DVT versus 119,555 (36.4%) right-sided, with 55,555 bilateral and 16,865 unspecified. Among patients with a prior colectomy, 5,750 (41.2%) were left-sided, 5,000 (35.9%) were right-sided, 2,345 were bilateral and 850 were unspecified. The laterality distribution between the two groups was not significantly different ( = .167). The left-side predominance disappeared only in males with a prior colectomy (37.1% for left vs. 38.9% for right, = .027).
Our findings did not confirm the Burkitt's hypothesis. The left-side predominance of lower extremity DVT was attenuated only in male patients with a prior colectomy.
深静脉血栓（DVT）已知更易发生于左下肢。著名外科医生 Denis Burkitt 提出理论，认为沉重的乙状结肠会压迫左侧骨盆静脉，从而易导致 DVT。我们的研究旨在通过比较有和无先前结肠切除术的病例的侧别分布来评估这一假说。
我们通过分层分析 2016 年国家住院患者样本数据库中任何年龄的下肢急性 DVT 患者是否有先前的结肠切除术史，从而消除了局部肠道机械因素对 DVT 发展的影响。我们比较了有和无先前结肠切除术的患者的侧别分布（即左侧、右侧、双侧和未指定）。我们还按性别类别进行了亚组分析，以检查男性和女性患者侧别分布的差异。采用独立性卡方检验。P 值≤0.05 被认为具有统计学意义。
我们共发现了 342525 例估计病例。在无先前结肠切除术的患者中，有 136605 例（41.6%）为左侧 DVT，119555 例（36.4%）为右侧，55555 例为双侧，16865 例为未指定。在有先前结肠切除术的患者中，有 5750 例（41.2%）为左侧，5000 例（35.9%）为右侧，2345 例为双侧，850 例为未指定。两组之间的侧别分布无显著差异（ = .167）。只有先前接受结肠切除术的男性患者中，左侧优势消失（左侧为 37.1%，右侧为 38.9%， = .027）。
我们的发现并未证实 Burkitt 的假说。先前接受结肠切除术的男性患者中，下肢 DVT 的左侧优势仅减弱。
