原发性下肢深静脉功能不全返流程度的彩色多普勒超声研究
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摘要
[目的] 研究彩色多普勒超声在诊断下肢深静脉有无返流及和评判返流
程度中的应用价值。主要探讨返流距离是否可以作为评判下肢深静脉返流
程度的指标。
[方法] 应用彩色多普勒超声对 45 例（46 条下肢）经 X 线逆行造影诊
断的不同程度的原发性下肢深静脉功能不全的患者和同期无年龄差异的自
愿者 20 例（40 条下肢）进行彩色多普勒超声检查，对两组的超声检查结果
进行对比分析。本研究重点是对患病组的 X 线逆行造影结果和超声测量的
参数进行等级相关性分析。X 线逆行造影结果根据 Kinster 的标准将下肢深
静脉功能不全分为四级。彩色多普勒超声检查采用统一的仪器和扫查方法，
股浅静脉内返流信号的引出采用统一的乏氏法。将患病组以 X 线逆行造影
检查结果为标准，研究平卧位下彩色多普勒检测的股浅静脉内径，乏氏试
验时股浅静脉内血流返流时间、返流的距离与 X 逆行造影线检查的返流程
度的相关性。
[结果] 超声测量的股浅静脉内返流时间阈值为0.5s为诊断有无下肢静
脉功能不全比较合适，与多数研究结果相一致。高分辨率超声可清晰显示
静脉壁和瓣膜的解剖结构，为临床提供可靠的静脉及瓣膜的形态学信息，
两组均有较高的显示率（对照组为 75%，患病组为 76%）。超声测得股浅静
脉内径与 X 线检查的深静脉返流程度相关有高度统计学意义（r=0.771）超
声测得股浅静脉返流时间与 X 线检查得深静脉返流程度相关性无统计学意
义（r=0.247），但返流的距离和 X 线检查的返流程度相关性有统计学意义
（r=0.910）。
[结论] 彩色多普勒为诊断和鉴别诊断原发性下肢静脉功能不全提供
可靠的影像学依据。股浅静脉内血流返流的距离是评判静脉返流程度的有
用的指标。 超声检测的无创、实时动态、可重复性等优点使超声在判断下
肢深静脉返流及返流的程度中发挥重要的作用。
[Objective] To study the value of color Doppler ultrasonography in
diagnosing the deep venous insufficiency and assessing the severity of deep
venous insufficiency of the lower extremities. And mainly to evaluate that
whether or not the reflux distance in superficial femoral veins in can be used as
a parameter in evaluating the degree of deep venous insufficiency.
[Methods] 45 patients (46 lower extremities) in patient group confirmed
as venous insufficiency by descending phlebography and 20 volunteers (40
lower extremities) in control group were assessed by color Doppler
ultrasonography . The results of 45 patients were compared with that of 20
volunteers. According to Kinster, the descending phlebography classified the
severity of venous insufficiency in four degrees. All patients and volunteers
above were examined in supine position. Valsalva method was employed in
evoking reflux in superficial femoral veins. And the diameters of superficial
femoral vein， the duration of reflux time and the distance of reflux measured
by color Doppler ultrasonography in 45 patients were compared with the
degrees showed in descending phlebography.
[Results] It was reasonable that reflux time threshold value of venous
reflux in superficial femoral veins was defined as reverse flow for greater than
0.5 second by color Doppler ultrasonography. The structure of vein and first
valve of superficial femoral vein were showed in high-resolution
ultrasonography clearly. The diameters of superficial femoral vein measured by
color Doppler ultrasonography were correlated with the severity of venous
reflux showed in phlebography(r=0.771). And the distance of reflux was
correlated with the severity of venous reflux showed in phlebography(r=0.910).
but not the reflux time(r=0.247).
[Conclusion] Color Doppler ultrasonography can provide reliable imaging for
III
doctors in diagnosing and distinguishing deep venous insufficiency. The reflux
distance in superficial femoral vein is useful parameter in assessing the degree
of venous insufficiency. Ultrasonography with its characteristics of non-damage,
real-time imaging and reproducibility will play an important role in diagnosing
and assessing the severity of deep venous insufficiency.
程度中的应用价值。主要探讨返流距离是否可以作为评判下肢深静脉返流
程度的指标。
[方法] 应用彩色多普勒超声对 45 例（46 条下肢）经 X 线逆行造影诊
断的不同程度的原发性下肢深静脉功能不全的患者和同期无年龄差异的自
愿者 20 例（40 条下肢）进行彩色多普勒超声检查，对两组的超声检查结果
进行对比分析。本研究重点是对患病组的 X 线逆行造影结果和超声测量的
参数进行等级相关性分析。X 线逆行造影结果根据 Kinster 的标准将下肢深
静脉功能不全分为四级。彩色多普勒超声检查采用统一的仪器和扫查方法，
股浅静脉内返流信号的引出采用统一的乏氏法。将患病组以 X 线逆行造影
检查结果为标准，研究平卧位下彩色多普勒检测的股浅静脉内径，乏氏试
验时股浅静脉内血流返流时间、返流的距离与 X 逆行造影线检查的返流程
度的相关性。
[结果] 超声测量的股浅静脉内返流时间阈值为0.5s为诊断有无下肢静
脉功能不全比较合适，与多数研究结果相一致。高分辨率超声可清晰显示
静脉壁和瓣膜的解剖结构，为临床提供可靠的静脉及瓣膜的形态学信息，
两组均有较高的显示率（对照组为 75%，患病组为 76%）。超声测得股浅静
脉内径与 X 线检查的深静脉返流程度相关有高度统计学意义（r=0.771）超
声测得股浅静脉返流时间与 X 线检查得深静脉返流程度相关性无统计学意
义（r=0.247），但返流的距离和 X 线检查的返流程度相关性有统计学意义
（r=0.910）。
[结论] 彩色多普勒为诊断和鉴别诊断原发性下肢静脉功能不全提供
可靠的影像学依据。股浅静脉内血流返流的距离是评判静脉返流程度的有
用的指标。 超声检测的无创、实时动态、可重复性等优点使超声在判断下
肢深静脉返流及返流的程度中发挥重要的作用。
[Objective] To study the value of color Doppler ultrasonography in
diagnosing the deep venous insufficiency and assessing the severity of deep
venous insufficiency of the lower extremities. And mainly to evaluate that
whether or not the reflux distance in superficial femoral veins in can be used as
a parameter in evaluating the degree of deep venous insufficiency.
[Methods] 45 patients (46 lower extremities) in patient group confirmed
as venous insufficiency by descending phlebography and 20 volunteers (40
lower extremities) in control group were assessed by color Doppler
ultrasonography . The results of 45 patients were compared with that of 20
volunteers. According to Kinster, the descending phlebography classified the
severity of venous insufficiency in four degrees. All patients and volunteers
above were examined in supine position. Valsalva method was employed in
evoking reflux in superficial femoral veins. And the diameters of superficial
femoral vein， the duration of reflux time and the distance of reflux measured
by color Doppler ultrasonography in 45 patients were compared with the
degrees showed in descending phlebography.
[Results] It was reasonable that reflux time threshold value of venous
reflux in superficial femoral veins was defined as reverse flow for greater than
0.5 second by color Doppler ultrasonography. The structure of vein and first
valve of superficial femoral vein were showed in high-resolution
ultrasonography clearly. The diameters of superficial femoral vein measured by
color Doppler ultrasonography were correlated with the severity of venous
reflux showed in phlebography(r=0.771). And the distance of reflux was
correlated with the severity of venous reflux showed in phlebography(r=0.910).
but not the reflux time(r=0.247).
[Conclusion] Color Doppler ultrasonography can provide reliable imaging for
III
doctors in diagnosing and distinguishing deep venous insufficiency. The reflux
distance in superficial femoral vein is useful parameter in assessing the degree
of venous insufficiency. Ultrasonography with its characteristics of non-damage,
real-time imaging and reproducibility will play an important role in diagnosing
and assessing the severity of deep venous insufficiency.
引文
[1] Guarnera G, Furgiuele S , Mascellari L. et al. External Banding
Valvuloplasty of the Superficial Femoral Vein in the Treatment of Recurrent
Varicose Veins. Inter Angiol, 1998, 17(4):268-272
[2] Magnusson MB, Nelzen O, Risberg B. A Colour Doppler Ultrasound Study
of Venous Reflux in Patients with Chronic Leg Ulcers. Enu J Vasc
Endovasc。 Surg.2001, 21:353-360.
[3] Paul L. Allan, Paul A. Dubbins, Myron A. et al. Clinical Doppler
Ultrasound. CHURCHILL LIVINGSTONE. An Imprint of Harcourt
Publishers Limited 2000. First Published 2000 ： 89-109 。 ISBN O443
O55491.
[4]吴阶平，裘法祖，主编。黄家驷外科学。第六版，北京，2000：
885~889。
[5] Masud M, Kistner RL. Long-term Results of Venous Valve Reconstruction :
A Four to Twenty-one Year Follow-up. J Vasc Surg 1994,19:391~403.
[6] Kistner R, Masud R.A Practical Approach to the Diagnosis and
Classification if Chronic Venous Disease. In:Rutherford W, eds . Vascular
Surgery , 5th ed .Philadelphia: Saunders, 200,1990~1999.
[7]Makarova NP, Lurie F, Hmelniker SM, et al. Does Surgical Correction of the
Superficial Femoral Vein Valve Change the Course of Varicose Disease. J
Vasc Surg,2001,33:361~368.
[8] Herman RJ, Neiman HL, Yao JST, et al. Descending venougraphy: A
method of evaluating lover extremity venous valvular fanction. Radiology,
1980,137:63~68.
[9] Grabs A J, Wakely MC, Nyamekye I, et al. Color Duplex Ultrasonography
in the Rational Management of Chronic Venous Leg Ulcers . Br J
Surg,1996, 83: 1380~1388.
１８
山西医科大学硕士学位论文
［１０］郝风鸣，唐杰，徐建宏，等，彩色多普勒在原发性深静脉瓣膜功能不
全检查中的应用。中国超声医学杂志，１９９１，７（３）：１９５￣１９６。
[11]Van Bemmelen PS, Bench K, Bedford G , et al. The Mechanism of Venous
Valve Closure: Its Relationship to the Velocity of Reverse Flow. Arch Surg.
1990, 125:617~619.
[12]徐秋华，燕三，龚雪萌，等。下肢深静脉功能的彩超诊断。中国超声
医学杂志，1998，14（5）：59~60。
[13] Clarke GH，Vasdekis SN， Hobbs JT，et al. Venous Wall Function in
the Pathogenesis of Varicose Veins. Surgery, 1992,111:402-408.
[14] Von Itter C, Harter T, Rabe E. Color-code Doppler Sonography in
Chronic Venous Insufficiency. Aktuelle-Radiol, 1991,1(5): 239~242.
[15] 冯友贤. 主编血管外科学, 第二版,上海科学技术出版社出版.1992,5 月,
上海,第二版:516~523。
[16] Walsh JC,Bergan JJ, Moulton SL, et al. Proximal Reflux Adversely Affect
Distal Venous Funtion. J Vasc Surg, 1996, 30:89~95.
[17]蒋米尔，陆民，黄新天，等。股浅静脉瓣膜包窄术治疗下肢深静脉
瓣膜功能不全的评价。中国现代普通外科进展，2001，4：45-47
[18] Robert JM, Neil MK, Piyush G. Doplex Ultrasound Evaluation of Lower
Extremity Venous Insufficiency. J Vasc and Inter Rad. 2003,14(10):1233-
1241.
[19]查长松，赵玉华，李燕萍，等。正常下肢静脉的二维彩色多普勒血流
显像检查。中国超声医学杂志，1999，15（2）：109-111。
[20] Van Bemmelen PS， Bedford G， Beach KW，et al. Quantitative
Segmental Evaluation of Venous Valvular Reflux with Duplex Ultrasound
Scanning。J Vasc Surg, 1989，10：425-431。
[21] Masuda EM，Kister RL. Prospective Comparison of Duplex Scanning
１９
山西医科大学硕士学位论文
and Descending Venography in the Assessment of Venous Insufficiency.
Am J Surg. 1992,164:254~257.
[22] 查长松，赵玉华，黄晓云，等. 二维彩色多普勒血流显像检测下肢
慢性静脉瓣膜功能不全. 中国超声医学杂志,1998, 14（6）:35~37.
[23] 陆信武，徐秋华，蒋米尔。彩色多普勒超声评价下肢静脉倒流时间阈
值的研究。中华超声影像学杂志，2002，11（12）743——745。
[24]Magnusson M, Alebo P, Lukes P, et al. Colour Dppler Diagnosing Venous
Insuffiiciency. A Comparison to Descending Phelobgraphy. Vasc-
Endovasc-Surg.1995, 9(4): 437~439.
[25] 郭金发，李慧珍，张征，等。彩色多普勒血流显像诊断原发性下肢深
静脉瓣膜功能不全的价值。临床超声医学杂志，2002年 4（5）：228-
229。
[26] Rodriguez AA, Whitehead CM, McLaughlinRL, et al. Duplex-derived
Valve Closure Times Fail to Correlatewith Reflux Flow Volumesin
Patients withChronic Venous Insufficiency. :J Vasc Surg ，1996, 23(4):
606~610.
[27] 马桂英，李娜，鲁豫。探讨下肢静脉瓣膜功能不全的二维彩色多普勒
超声图像改变。中国超声医学杂志，2000，16（11）：864-867
[28] Hu，ZJ， Wang SM， Wang YM，et al。Quantitative Assessment of the
Degree of Deep Venous Reflux of the Lower Extremities。 Asian J Surg.
2003，26(2):108-111.
[29] 徐秋华，燕三，龚雪萌，等。下肢静脉瓣膜功能的血流动力学评价。
中国超声医学杂志，1998，14（11）：38~40。
[30] 宋烨，陈苏宁，姜伟庆。探讨二维超声血流显像技术在下肢深静脉倒
流性疾病中的价值。中国医学影像技术，2003，19（1）48-50。
２０
山西医科大学硕士学位论文
[31] 张柏根。慢性下肢静脉功能不全的诊治进展。中华普通外科杂志，
2003 18（9）：517-518。
[32] Nicos LB, Jay TG, Landon PR, et al. Definition of Venous Reflux in
Lower-Extremity Veins. J Vasc Surg, 2003, 38(4):793-798.
Valvuloplasty of the Superficial Femoral Vein in the Treatment of Recurrent
Varicose Veins. Inter Angiol, 1998, 17(4):268-272
[2] Magnusson MB, Nelzen O, Risberg B. A Colour Doppler Ultrasound Study
of Venous Reflux in Patients with Chronic Leg Ulcers. Enu J Vasc
Endovasc。 Surg.2001, 21:353-360.
[3] Paul L. Allan, Paul A. Dubbins, Myron A. et al. Clinical Doppler
Ultrasound. CHURCHILL LIVINGSTONE. An Imprint of Harcourt
Publishers Limited 2000. First Published 2000 ： 89-109 。 ISBN O443
O55491.
[4]吴阶平，裘法祖，主编。黄家驷外科学。第六版，北京，2000：
885~889。
[5] Masud M, Kistner RL. Long-term Results of Venous Valve Reconstruction :
A Four to Twenty-one Year Follow-up. J Vasc Surg 1994,19:391~403.
[6] Kistner R, Masud R.A Practical Approach to the Diagnosis and
Classification if Chronic Venous Disease. In:Rutherford W, eds . Vascular
Surgery , 5th ed .Philadelphia: Saunders, 200,1990~1999.
[7]Makarova NP, Lurie F, Hmelniker SM, et al. Does Surgical Correction of the
Superficial Femoral Vein Valve Change the Course of Varicose Disease. J
Vasc Surg,2001,33:361~368.
[8] Herman RJ, Neiman HL, Yao JST, et al. Descending venougraphy: A
method of evaluating lover extremity venous valvular fanction. Radiology,
1980,137:63~68.
[9] Grabs A J, Wakely MC, Nyamekye I, et al. Color Duplex Ultrasonography
in the Rational Management of Chronic Venous Leg Ulcers . Br J
Surg,1996, 83: 1380~1388.
１８
山西医科大学硕士学位论文
［１０］郝风鸣，唐杰，徐建宏，等，彩色多普勒在原发性深静脉瓣膜功能不
全检查中的应用。中国超声医学杂志，１９９１，７（３）：１９５￣１９６。
[11]Van Bemmelen PS, Bench K, Bedford G , et al. The Mechanism of Venous
Valve Closure: Its Relationship to the Velocity of Reverse Flow. Arch Surg.
1990, 125:617~619.
[12]徐秋华，燕三，龚雪萌，等。下肢深静脉功能的彩超诊断。中国超声
医学杂志，1998，14（5）：59~60。
[13] Clarke GH，Vasdekis SN， Hobbs JT，et al. Venous Wall Function in
the Pathogenesis of Varicose Veins. Surgery, 1992,111:402-408.
[14] Von Itter C, Harter T, Rabe E. Color-code Doppler Sonography in
Chronic Venous Insufficiency. Aktuelle-Radiol, 1991,1(5): 239~242.
[15] 冯友贤. 主编血管外科学, 第二版,上海科学技术出版社出版.1992,5 月,
上海,第二版:516~523。
[16] Walsh JC,Bergan JJ, Moulton SL, et al. Proximal Reflux Adversely Affect
Distal Venous Funtion. J Vasc Surg, 1996, 30:89~95.
[17]蒋米尔，陆民，黄新天，等。股浅静脉瓣膜包窄术治疗下肢深静脉
瓣膜功能不全的评价。中国现代普通外科进展，2001，4：45-47
[18] Robert JM, Neil MK, Piyush G. Doplex Ultrasound Evaluation of Lower
Extremity Venous Insufficiency. J Vasc and Inter Rad. 2003,14(10):1233-
1241.
[19]查长松，赵玉华，李燕萍，等。正常下肢静脉的二维彩色多普勒血流
显像检查。中国超声医学杂志，1999，15（2）：109-111。
[20] Van Bemmelen PS， Bedford G， Beach KW，et al. Quantitative
Segmental Evaluation of Venous Valvular Reflux with Duplex Ultrasound
Scanning。J Vasc Surg, 1989，10：425-431。
[21] Masuda EM，Kister RL. Prospective Comparison of Duplex Scanning
１９
山西医科大学硕士学位论文
and Descending Venography in the Assessment of Venous Insufficiency.
Am J Surg. 1992,164:254~257.
[22] 查长松，赵玉华，黄晓云，等. 二维彩色多普勒血流显像检测下肢
慢性静脉瓣膜功能不全. 中国超声医学杂志,1998, 14（6）:35~37.
[23] 陆信武，徐秋华，蒋米尔。彩色多普勒超声评价下肢静脉倒流时间阈
值的研究。中华超声影像学杂志，2002，11（12）743——745。
[24]Magnusson M, Alebo P, Lukes P, et al. Colour Dppler Diagnosing Venous
Insuffiiciency. A Comparison to Descending Phelobgraphy. Vasc-
Endovasc-Surg.1995, 9(4): 437~439.
[25] 郭金发，李慧珍，张征，等。彩色多普勒血流显像诊断原发性下肢深
静脉瓣膜功能不全的价值。临床超声医学杂志，2002年 4（5）：228-
229。
[26] Rodriguez AA, Whitehead CM, McLaughlinRL, et al. Duplex-derived
Valve Closure Times Fail to Correlatewith Reflux Flow Volumesin
Patients withChronic Venous Insufficiency. :J Vasc Surg ，1996, 23(4):
606~610.
[27] 马桂英，李娜，鲁豫。探讨下肢静脉瓣膜功能不全的二维彩色多普勒
超声图像改变。中国超声医学杂志，2000，16（11）：864-867
[28] Hu，ZJ， Wang SM， Wang YM，et al。Quantitative Assessment of the
Degree of Deep Venous Reflux of the Lower Extremities。 Asian J Surg.
2003，26(2):108-111.
[29] 徐秋华，燕三，龚雪萌，等。下肢静脉瓣膜功能的血流动力学评价。
中国超声医学杂志，1998，14（11）：38~40。
[30] 宋烨，陈苏宁，姜伟庆。探讨二维超声血流显像技术在下肢深静脉倒
流性疾病中的价值。中国医学影像技术，2003，19（1）48-50。
２０
山西医科大学硕士学位论文
[31] 张柏根。慢性下肢静脉功能不全的诊治进展。中华普通外科杂志，
2003 18（9）：517-518。
[32] Nicos LB, Jay TG, Landon PR, et al. Definition of Venous Reflux in
Lower-Extremity Veins. J Vasc Surg, 2003, 38(4):793-798.