腔内治疗髂静脉受压综合征的疗效分析  

Efficacy analysis of endovascular therapy for iliac vein compression syndrome

作　　者：张安冬[1] 高涌[1] 聂中林[1] 余朝文[1] 陈世远[1] 王孝高[1] 徐超[1] ZHANG Andong GAO Yong NIE Zhonglin YU Chaowen CHEN Shiyuan WANG Xiaogao XU Chao(Department of Vascular Surgery, the First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233004, Chin)

机构地区：[1]蚌埠医学院第一附属医院血管外科,安徽蚌埠233004

出　　处：《中国普通外科杂志》2016年第12期1751-1756,共6页China Journal of General Surgery

摘　　要：目的：探讨腔内治疗髂静脉受压综合征（IVCS）的疗效。 方法：回顾性分析2014年1月—2015年12月收治的244例腔内治疗的IVCS患者临床资料。 结果：全组无手术死亡，1例患者左髂静脉完全闭塞，放弃腔内治疗，技术成功率99.6%（243/244）。243例患者中94例行单纯球囊扩张，149例行球囊扩张联合支架植入术，175例合并下肢静脉曲张者行二期手术治疗。224例随访3-27个月，期间患者静脉曲张无复发，左下肢肿胀均得到不同程度缓解，总有效率达100%；63例皮肤色素沉着得到不同程度减退，30例静脉性溃疡患者得到愈合或缓解。单纯球囊扩张患者与球囊扩张联合支架植入患者的左下肢肿胀完全缓解率、溃疡完全愈合率、髂静脉再狭窄或血栓形成率在术后6个月时均无统计学差异（96.0% vs.99.0%、84.6% vs.100.0%、5.3% vs.2.0%，均P〉0.05），但术后12、24个月时，后者均明显优于前者（70.0% vs.96.0%、61.5% vs.94.1%、12.8% vs.2.0%；60.9% vs.94.8%、53.8% vs.94.1%、23.5% vs.2.1%，均P〈0.05）。 结论：腔内治疗IVCS具有良好的近、中期疗效。联合支架植入的中期疗效优于单纯球囊扩张。选择合适的支架类型、支架直径、支架长度；精确合理地定位支架；规律足量的抗凝治疗，对于保证远期疗效具有重要作用。Objective：To investigate the clinical efficacy of endovascular therapy for iliac vein compression syndrome （IVCS）. Methods：hTe clinical data of 244 patients with IVCS undergoing endovascular treatment from January 2014 to December 2015 were retrospectively analyzed. Results：No surgical death occurred in the entire group, and endovascular treatment was abandoned in one case due to complete occlusion of the left iliac vein, so the technical success rate was 99.6%（243/244）. Of the 243 patients, 94 cases underwent balloon dilatation alone, and 149 cases received balloon dilatation with stent implantation;175 cases with varicose veins of lower limbs were subjected to a second stageoperation. Two hundred and twenty-four patients were followed up for 3 to 27 months, during which time, no relapse of varicose veins was observed;the lower limb swelling was alleviated with varying degrees in all patients, and the treatment effective rate was 100%;hyperpigmentation was reduced with varying degrees in 63 patients, and alleviation or healing was seen in 30 patients with venous ulcer. The rate of complete relief of the left lower limb swelling, complete ulcer healing and restenosis or thrombosis formation in the iliac vein showed no signiifcant difference on postoperative 6 months between patients undergoing balloon dilatation alone and balloon dilatation plus stent implantation （96.0%vs. 99.0%, 84.6%vs. 100.0%and 5.3%vs. 2.0%, all P〉0.05）, but were signiifcantly better in the latter than the former on postoperative 12 and 24 months （70.0%vs. 96.0%, 61.5%vs. 94.1%and 12.8%vs. 2.0%;60.9%vs. 94.8%, 53.8%vs. 94.1%and 23.5%vs. 2.1%, all P〈0.05）. Conclusion：In treatment of IVCS, endovascular therapy offers favorable short-and mid-term effcacy and the mid-term effcacy of balloon dilatation plus stenting is better than that of balloon dilatation alone. Selection of the suitable type, diameter and length of stents, accurate and appropriate stent placement, and regular and suffcient anticoagulant therapy h

关 键 词：May-Thurner综合征 髂静脉 血管内操作 

分 类 号：R654.3[医药卫生—外科学]