髂静脉压迫综合征的诊治路径及影响治疗效果的因素  

Clinical pathway and impact facors for treatment of Cockett syndrome

作　　者：欧阳林[1] 周满臻[2] 许斯鼎 何平[1] 陈水斌[1] 

机构地区：[1]中国人民解放军第一七五医院厦门大学附属东南医院医学影像科,福建漳州363000 [2]南京军区鼓浪屿疗养院护理部,福建厦门361002

出　　处：《中国介入影像与治疗学》2016年第7期406-410,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：漳州市科技计划项目(Z07019)

摘　　要：目的探讨髂静脉压迫综合征(IVCS)诊治路径及影响治疗效果的因素。方法收集在我院诊治的69例IVCS患者,患者在治疗前进行CT静脉成像。依据CT表现将IVCS分为单纯型IVCS(sIVCS,n=22)、腰椎退变相关型IVCS(dIVCS,n=33)和其他原因IVCS(oIVCS,n=14)。采用靶静脉置管溶栓、机械碎栓抽吸并球囊扩张、髂静脉支架植入的治疗方案。治疗结果为有效和无效。采用Logistic回归分析影响治疗结果的因素。结果单纯髂静脉置管溶栓,仅15例治疗有效(5例dIVCS和10例oIVCS);接受机械碎栓抽吸并球囊扩张的54例患者中,26例有效(6例sIVCS、16例dIVCS和4例oIVCS);37例接受支架植入患者髂静脉均有效开通且随访12个月无复发。Logistic回归分析表明IVCS类型(β=4.14,Wald检验P<0.01)、病程(β=-5.33,Wald检验P=0.02),血栓密度(β=-6.46,Wald检验P=0.01)、栓塞范围(β=2.74,Wald检验P=0.03)及治疗方案(β=11.92,Wald检验P=0.01)均对治疗结果有显著影响。结论针对不同类型IVCS的特点选择合理的介入治疗方法有利于提高疗效。Objective To explore the diagnostic and therapeutic pathway of iliac vein compression syndrome （IVCS, Cockett syndrome） in clinic, and analyze potential influential factors on therapeutic efficacy. Methods Sixty-nine patients with IVCS were arranged to perform CT venography （CTV） before interventional therapy. Based-on CT anatomic diversity of the iliac vein tunnel （IVT） and compressing factors of the iliac vein, IVCS were divided into simple IVCS （sIVCS, n=22）, lower lumbar degeneration-related IVCS （dIVCS, n=33） and other cause IVCS （oIVCS, n=14）. Therapeutic regimen was designed as programmed stage-treatment, namely targeted intravenous catheter-directed thrombosis, intravenous mechanically thromb-broken aspiration and balloon dilatation, iliac venous stent implantation. Therapeutic efficacy was ranked as effective treatment and invalid treatment （including relapse）. A Logistic regression analysis was used to evaluate the factors of affecting the therapeutic results. Results Only 15 of 69 cases were effectively cured by targeted intravenous catheter-directed thrombolysis, including 10 of oIVCSs and 5 of dIVCSs. The other 54 ineffectively-treated patients were arranged to accept thromb-broken and aspiration treatment and following intravenous balloon dilatation, of whom 26 cases obtained effective treatment （6 of sIVCSs, 16 of dIVCSs, 4 of oIVCSs ）. Then vessel stentings were performed in the stenotic iliac veins in 37 cases, all cases achieved satisfactory iliac vein patency without a recurring in a 12-month follow-up duration. Logistic regression analysis demonstrated that IVCS type （β=4.14, Wald test P〈0.01）, course of disease （β=-5.33, Wald test P=0.02）, thromb density （β=-6.46, Wald test P=0.01）, scope of embolism （β=2.74, Wald test P=0.03） and treatment plan （β=11.92, Wald test P=0.01） markedly influenced the therapeutic results. Conclusion According to the characteristics of different types of IVCS, reasonable choice of interventional therapeutic

关 键 词：髂静脉压迫综合征 放射学 介入性 疗效 影响因素 

分 类 号：R543.6[医药卫生—心血管疾病] R815[医药卫生—内科学]