目的:盆腔静脉疾病(PeVD)的治疗仍存在争议。开放手术和血管内方法目前用于治疗,但文献中关于输卵管卵巢静脉(OV)的形态学和组织学的数据很少。这项研究旨在探讨PeVD患者扩张OV的组织形态学变化,并将其与死后获得的正常OV和正常大隐静脉(GSV)进行比较。
方法:在16例因PeVD而接受手术的患者中研究了OV的组织学,10具对照尸体,在尸检时从其身上采集了OV碎片,没有明显的总体变化,和9名对照组患者,其中GSV被切除用于冠状动脉搭桥术。
结果:PeVD患者的OV壁由三层组成:内膜,媒体,和外膜。OV看起来与GSV壁非常相似,因为平滑肌纤维层明显发达。正常OV的厚度与PeVD中的OV壁存在显着差异(475.3μm,IQR370.7,607.6vs.776.3μm,IQR668.9,879.6,p<.001),并且与正常GSV壁的厚度(784.3μm,IQR722.2,898.2)。在PeVD中,OV的内膜-中膜复合物明显薄于GSV(118.9μm,IQR75.6,159.6vs.415μm,IQR399.5,520.0,C.2<.001);然而,OV的外膜明显厚于正常OV和GSV(599.6μm,IQR444.3,749.7vs.373.5μm,IQR323.8,482.0vs.308.4μm,IQR275.9,338.2,p<.001)。
结论:PeVD患者的OV扩张伴随着静脉壁总厚度的显著增加,这使得它在结构上更接近GSV。这意味着OV可以安全地用于移位进入下腔静脉或髂静脉。
OBJECTIVE: The management of pelvic venous disorders (PeVD) remains controversial. Open surgical and endovascular methods are currently used for treatment, but there are few data in the literature on the morphology and histology of the ectatic ovarian vein (OV). This study aimed to explore the histomorphological changes in a dilated OV in patients with PeVD and compare it with a normal OV obtained post-mortem and a normal great saphenous vein (GSV).
METHODS: Histology of the OV was studied in 16 patients who underwent surgery for PeVD, 10 control cadavers from whom fragments of the OV without visible gross changes were taken at autopsy, and nine control patients in whom the GSV was resected to be used for coronary artery bypass.
RESULTS: The OV wall in patients with PeVD consisted of three layers: intima, media, and adventitia. The OV looked very similar to the GSV wall because of a clearly developed layer of smooth muscle fibres. The thickness of the normal OV was significantly different to the OV wall in PeVD (475.3 μm, IQR 370.7, 607.6 vs. 776.3 μm, IQR 668.9, 879.6, p < .001) and did not differ significantly from the thickness of a normal GSV wall (784.3 μm, IQR 722.2, 898.2). The intima-media complex of the OV was significantly thinner than the GSV in PeVD (118.9 μm, IQR 75.6, 159.6 vs. 415 μm, IQR 399.5, 520.0, р < .001); however, the adventitia of the OV was significantly thicker than in normal OV and GSV (599.6 μm, IQR 444.3, 749.7 vs. 373.5 μm, IQR 323.8, 482.0 vs. 308.4 μm, IQR 275.9, 338.2, p < .001).
CONCLUSIONS: Dilatation of the OV in patients with PeVD was accompanied by a significant increase in the overall thickness of the vein wall, which brings it closer in structure to the GSV. This implies that the OV may be used safely for transposition into the inferior vena cava or iliac vein.