以D-二聚体为依据对二期球囊扩张或支架置入治疗髂静脉狭窄伴血栓形成的监测作用  

Precise monitoring of iliac vein stenosis with thrombosis based on D-dimer in secondary balloon dilatation or stent placement

作　　者：黄强[1] 阮强[1] 郭伟昌[1] 黄智勇[1] 李昭辉[1] HUANG Qiang;RUAN Qiang;GUO Wei-Chang;HUANG Zhi-Yong;LI Zhao-Hui(Department of Vascular Surgery,Yibin First People′s Hospital,Yibin 644000,Sichuan Province,China)

机构地区：[1]宜宾市第一人民医院血管外科,四川宜宾644000

出　　处：《中华老年多器官疾病杂志》2021年第12期898-902,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：宜宾市科技局重点项目(2016YZY001)。

摘　　要：目的探讨以D-二聚体(D-D)为依据二期球囊扩张或支架置入对髂静脉狭窄伴血栓形成患者的临床疗效。方法选取2016年8月至2020年8月宜宾市第一人民医院髂静脉狭窄或闭塞伴血栓形成患者33例进行前瞻性研究,通过计算机软件产生随机数字,随机分成2组。试验组患者18例,一期置管溶栓术后,若3d内D-D升高缓慢(极差<10mg/L),第4天行下肢静脉造影并行8cm球囊行髂静脉扩张术。对照组患者15例,一期置管溶栓术后,第7天均行下肢静脉造影,根据造影结果考虑是否行髂静脉球囊扩张或支架置入术。比较2组患者术前及术后第6天D-D、膝下小腿周径、静脉反流时间、支架个数和使用率、出院天数和住院费用等。采用SPSS 19.0软件进行数据分析。根据数据类型,组间比较分别采用t检验或χ^(2)检验。结果试验组和对照组术前D-D水平比较,差异无统计学意义[(15.62±6.21)和(14.39±7.21)mg/L,P>0.05)];术后第6天D-D水平比较,差异有统计学意义[(28.37±7.01)和(20.54±5.78)mg/L,P<0.05)];出院时膝下15cm周径比较,差异无统计学意义[(1.2±0.6)和(1.3±0.8)cm,P>0.05)];出院时静脉反流时间比较,差异无统计学意义[(2.3±1.4)和(2.4±1.6)s,P>0.05)];住院时间比较,差异有统计学意义[(8.35±1.51)和(9.41±2.36)d,P<0.05];住院费用比较,差异有统计学意义[(56750.6±12387.8)和(65217.2±13585.7)元,P<0.05];支架置入情况比较,差异有统计学意义[3例(16.7%)和5例(33.3%),P<0.05]。治疗过程中2组均未出现如消化道大出血等危及生命的严重并发症。结论通过D-D水平对髂静脉狭窄伴血栓形成进行监测,可在早期达到同样效果时,提高溶栓效率,降低支架使用率和手术费用,并减少住院时间。Objective To investigate the clinical efficacy of secondary balloon dilatation or stenting based on D-dimer(D-D)in iliac vein stenosis with thrombosis.Method A prospective study was conducted in 33 patients with iliac vein stenosis or occlusion with thrombosis in Yibin First People′s Hospital from August 2016 to August 2020.They were randomized into study group(n=18)and control group(n=15),the former received lower extremity venography with balloon dilation iliac vein(8 cm)on the 4th day after the first-stage thrombolysis if the DD did not increase much(rang<10mg/L)within three days.The latter underwent venography of the lower extremities on day 7 after the first-stage thrombolysis,and ballooning dilation of the iliac vein or stenting would be considered according to the results of the angiography.The two groups were compared in the respects of D-D,calf circumference under the knee,venous reflux time,number of stents and usage rate,days of discharge and hospitalization expenses before surgery and on the 6th day after surgery.SPSS statistics 19.0 was used for statistical analysis.Depending on date type,data comparison between two groups was performed using t test orχtest.Result The study and control groups had no significant difference in DD before operation[(15.62±6.21)vs(14.39±7.21)mg/L,P>0.05]but significant difference on day 6 after operation showed[(28.37±7.01)vs(20.54±5.78)mg/L,P<0.05];no significant difference in the circumference at 15 cm below the knee at discharge[(1.2±0.6)vs(1.3±0.8)cm,P>0.05]and venous reflux time at discharge[(2.3±1.4)vs(2.4±1.6)s,P>0.05];significant differences in length of hospitalization[(8.35±1.51)vs(9.41±2.36)d,P<0.05],hospitalization expenses[(56750.6±12387.8)vs(65217.2±13585.7)yuan,P<0.05],and number of stenting[3(16.7%)vs 5(33.3%),P<0.05].During the treatment,there were no serious life-threatening complications such as gastrointestinal bleeding between two groups.Conclusion Monitoring iliac vein stenosis and thrombosis through the D-D level can improve the ef

关 键 词：静脉血栓形成 髂静脉狭窄 球囊扩张 支架植入 

分 类 号：R654.4[医药卫生—外科学]