左髂总静脉的形态学研究及其临床意义

目的：研究左髂总静脉（LCIV）受压部位及相邻节段的结构特征,以探讨LCIV受压段的血管重塑及力学特性.方法：解剖80例成年尸体（男42例,女38例）,观测LCIV受压段及相邻节段外径、右髂总动脉（RCIA）与LCIV的相交角度以及右髂总静脉（RCIV）相应部位的外径;随机选择18例标本采用 Masson染色,观测受压段及其近侧、远侧段以及对侧相应部位的平滑肌（SM）、弹力纤维（EF）、胶原纤维（CF）等组织成分的变化.结果：受压段静脉管壁塌陷、菲薄.与对侧相应部位及受压处近侧和远侧段相比,受压处管径扩大（P＜0.01）;与RCIV比较,LCIV各节段SM相对含量降低,而CF和EF相对含量增加（P＜0.05）;与相邻节段相比,除近侧段的EF以外,其他各项指标差异都具有显著的统计学意义（P＜0.05）.结论：（1）LCIV的受压,引起血流动力学改变,诱导血管重塑,管壁弹性成分改建以及粘连结构的出现.（2）上述形态改变进一步引起血流动力学紊乱,从而加剧组织学的改变.（3）这一系列变化可能是导致髂-股静脉血栓形成和髂静脉压迫综合征发生的重要原因.

The morphologic study on left common iliac vein and its clinical significance

Objective: To explore the possible mechanism of vascular remodeling and biomechanic characteristics of left common iliac vein by studying the morphology and the changes of elastic compositions of the compressed left common iliac vein(LCIV) and adjacent segments. Methods: Eighty cadavers fixed with formalin(male 42, female 38)were randomly selected, the transverse diameter (wafering), the intravenous band within the compressed LCIV and angle between LCIV and RCIA (right common iliac artery) were observed and measured. The compressed segments together with its distal and proximal segments in 18 samples were then removed, dehydrated, embedded in paraffin, sliced and stained with Messon technique. As a control, the corresponding portions in the opposite side to the compressed portion were removed and the above processes were operated. After that the structure changes (SM, EF, CF, thickness of vein wall) were observed and analyzed with the Beihang CM-2000B Biomedical Image Analysis System. Results: Compared with right side, the venous wall of the compressed LCIV was collapsed and its thickness became thinner (P<0.05). Compared with the proximal and distal portions compressed as well as the right, the transverse diameter of the compressed LCIV increased obviously (P<0.01), the relative content of smooth muscles reduced and the relative content of elastic fibers and collagen fibers increased (P<0.05). Conclusions: The LCIV compressed by the RCIA results in derangement of hemodynamics, which might improve vascular remodeling development including the change of mechanic structures in the vein wall and intravenous band formation. Those changes lead to further derangement of hemodynamics and abnormity of histology. It is those transformation of morphology and hemodynamics might be the possible pathogenesis of the iliac vein compression syndrome (IVCS) and the deep venous thrombosis.