介入治疗急性髂股静脉血栓  

Interventional therapy for acute iliofemoral venous thrombosis

作　　者：董典宁[1] 张十一[1] 金星[1] 吴学君[1] 种振岳[1] 张精勇[1] 孙岩[1] 侯向前[1] 

机构地区：[1]山东省立医院血管外科,济南250021

出　　处：《中国微创外科杂志》2007年第7期609-611,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨介入治疗急性髂股静脉血栓的临床疗效。方法 2004年2月～2006年4月对20例急性髂股静脉血栓采用超声引导下腘静脉置管溶栓联合髂静脉支架植入治疗,静脉造影评价静脉通畅程度。结果 20例均在超声引导下腘静脉置管溶栓;15例行球囊扩张及髂静脉支架术,5例行单纯球囊扩张术;10例行临时性下腔静脉滤器置入术。腘静脉置管溶栓后经导管静脉造影见髂静脉再通率30%～90%,平均55%;股静脉再通率40%～80%,平均65%。1例术后出现血尿,未发现症状性肺动脉栓塞。术后患肢临床症状明显减轻或消失。住院费用（5.2～8.1）万元,平均7.4万元。20例随访1～24个月,平均12个月,15例髂静脉支架植入髂静脉通畅率100%（15/15）,5例髂静脉球囊扩张中,2例髂静脉完全闭塞,3例髂静脉再通10%～20%。结论 腘静脉置管溶栓术联合髂静脉支架植入术是治疗急性髂股静脉血栓的有效方法之一,但是价格昂贵,广泛应用有一定困难。Objective To investigate the clinical effect of interventional therapy in the treatment of acute iliofemoral venous thrombosis. Methods A total of 20 patients with acute iliofemoral venous thrombosis was treated by interventional therapy from February 2004 to April 2006. Under the guidance of ultrasonography, intravenous thrombolysis through the popliteal vein combined with iliac vein stenting was employed. The venous pateney was assessed with angiography. Results The eatheter-based thrombolysis through the ipsilateral popliteal vein was effective for all the patients. Balloon dilatation angioplasty combined with endovaseular stenting was applied in 15 patients, while balloon dilatation angioplasty alone was utilized in other 5 patients. The implantation of a temporary cava filter was required in 10 patients. After intravenous thrombolysis through the popliteal vein, the recanalization rate was 30% -90% （mean, 55% ） in the lilac vein and 40% - 80% （mean, 65% ） in the femoral vein. Postoperative hematuria was encountered in 1 patient. No symptomatic embolism of puhnonary artery, was seen. Postoperatively, clinical symptoms on the effeeted limb significantly subsided or completely disappeared. The hospitalization expenditure was 52 000 - 81 000 yuan （mean, 74 000 yuan）. Follow-up observations for 1 - 24 months （mean. 12 months） were earried out in the 20 patients. The pateney rate was 100% （15/15） in 15 patients receiving iliac vein stenting. Out of 5 patients with balloon dilatation, the iliac vein was completely obstructed in 2 patients and was reeanalized by 10% - 20% in 3 patients. Conclusions Catheter-based thrombolysis through the popliteal vein combined with endovascular stenting is an effective therapeutic strategy for acute iliofemoral venous thrombosis, but it is very expensive.

关 键 词：深静脉血栓形成 髂股静脉 溶栓 支架 

分 类 号：R543[医药卫生—心血管疾病]