外周途径置管溶栓治疗左髂静脉压迫并急性下肢深静脉血栓形成的分析  

Catheter Directed Thrombolysis Through Three Different Approaches Combined with Iliac Venous Endo vascular Therapy for Acute Deep Venous Thrombosis Complicated with Cockett Syndrome of Lower Extremities

作　　者：卢辉俊[1] 刘辉[1] 原野[1] 马兵兵[1] 张米[1] 胡亚立[1] 赵翼[1] 

机构地区：[1]南京医科大学附属无锡市人民医院血管外科,江苏无锡214023

出　　处：《中国普外基础与临床杂志》2015年第5期605-609,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结3种不同入路途径置管溶栓联合髂静脉腔内治疗髂静脉受压综合征合并急性下肢深静脉血栓形成（DVT）的临床疗效。方法回顾性分析我院2011年2月至2014年8月期间87例髂静脉受压综合征并发急性髂股DVT患者经3种途径（经小隐静脉、经腘静脉及经胫后静脉入路）置管溶栓再行髂静脉腔内成形术患者的临床资料。结果患者皆于术后72 h内下肢肿胀明显消退,无手术死亡和症状性肺动脉栓塞发生。经小隐静脉、经腘静脉及经胫后静脉入路的肢体消肿率分别为（77±13）%、（82±12）%及（77±18）%,3种入路间两两比较差异无统计学意义（P〉0.05）;再通率依次为（86.5±10.6）%、（92.0±7.7）%及（87.3±7.8）%,3种入路间两两比较差异无统计学意义（P〉0.05）;3组成功置管时间分别为（32.62±9.36）min、（42.79±13.30）min及（15.14±3.62）min,3种入路间两两比较差异有统计学意义（P〈0.01）,即与经小隐静脉和经腘静脉入路置管相比,经胫后静脉入路置管耗时较短,且时间较稳定。本组所有左髂静脉病变均予球囊扩张＋支架置入。随访1~24个月,髂静脉一期通畅率为100%。结论置管溶栓联合腔内治疗是治疗髂静脉受压综合征合并急性下肢DVT的有效方法,经胫后静脉途径入路置管溶栓操作简单、成功率高、时间短、术后并发症少,能够在基层医院普及。Objective To investigate the clinical efficacy of catheter directed thrombolysis （CDT） through three different approaches combined with iliac venous endovascular therapy for acute deep venous thrombosis （DVT） complicated with Cockett syndrome of the lower extremities. Method The clinical data of 87 patients with CDT through three different approaches （small saphenous vein group, popliteal vein group, and posterior tibial vein group） combined with iliac venous endovascular therapy for DVT complicated with Cockett syndrome of the lower extremities were analyzed retrospectively. Results The lower extremity swelling of aU the patients were disappeared obviously within 72 h after surgery, there was no death related surgery and pulmonary embolism. The limb edema reduction rates had no significant differences among the small saphenous vein group, popliteal vein group, and posterior tibial vein group [（77±13） % versus （82±12） % versus （77±18） %, P〉0.05]. The recanalization rates of thrombolysis had no significant differences among the above three groups [ （86.5±10.6） % versus （92.0±7.7） % versus （87.3±7.8） %, P〉0.053. The time required for the cannulation in the posterior tibial vein group was significantly shorter than that of the small saphenous vein group or popliteal vein group [ （15.14±3.62） min versus （32.62±9.36） min or （42.79± 13.30） min, P〈0.01]. All the patients were performed by balloon dilatation and iliac vein stenting. Eighty-seven cases were followed-up for 1-24 months, the primary patency rate of iliac venous was 100%. Conclusions CDT with iliac venous endovascular therapy is an effective method in treatment of acute DVT with Cockett syndrome. CDT through posterior tibial vein is an easier and effective method with less complications and time. This way could be acceptable in basal hospital.

关 键 词：置管途径 置管溶栓 COCKETT综合征 深静脉血栓形成 腔内成形术 

分 类 号：R654.4[医药卫生—外科学]