一期治疗髂静脉狭窄对急性下肢深静脉血栓形成合并髂静脉压迫综合征的疗效  

The efficacy of one-stage treatment on iliac vein stenosis for acute lower extremity deep venous thrombosis with iliac vein compression syndrome

作　　者：陈陈准 陈秋文[1] 林裕辉 陈剑洪 蔡梓凯 CHEN Chen-zhun;CHEN Qiu-wen;LIN Yu-hui;CHEN Jian-hong;CAI Zi-kai(Department of General Surgery,Jieyang People's Hospital,Jieyang 522000,Guangdong,China)

机构地区：[1]揭阳市人民医院普通外科一区,广东揭阳522000

出　　处：《广东医学》2022年第3期316-320,共5页Guangdong Medical Journal

摘　　要：目的探讨一期治疗髂静脉狭窄在急性下肢深静脉血栓形成合并髂静脉压迫综合征诊疗中的作用。方法回顾性分析合并髂静脉压迫综合征的急性下肢深静脉血栓患者56例。其中一期治疗组患者在接受介入下机械血栓清除或手动吸栓治疗后,同期行髂静脉狭窄球囊扩张或支架置入术,共21例。二期治疗组在首次手术时仅接受机械血栓清除或手动吸栓,行导管溶栓治疗后二期再行髂静脉腔内成形或支架置入术,共计35例。两组患者在首次手术时均先行下腔静脉滤器置入。比较一期和二期开通髂静脉梗阻治疗效果的区别。结果与二期治疗组比较,一期治疗组患者的溶栓导管留置时间短(P<0.001)、尿激酶使用量较少(P<0.001)、住院时间较短(P=0.009)。一期治疗组手术即时临床缓解率高于二期治疗组[(90.5%vs 60.0%),P=0.032]。而两组血栓清除率、治疗前后静脉通畅评分差值、治疗前后大腿周径差、小腿周径差的差异无统计学意义(P>0.05)。两组患者术中出血量、围手术期出血事件的差异无统计学意义(P>0.05)。随访期间,两组患者静脉通畅率与Villalta评分差异无统计学意义(P>0.05)。结论对于合并髂静脉压迫综合征的急性下肢深静脉血栓形成患者,一期解除髂静脉狭窄有利于迅速改善急性血栓性髂静脉狭窄患者临床症状,减少溶栓时间和住院时间,是安全有效的治疗方法。Objective To evaluate the efficacy of one-stage treatment of iliac vein stenosis in the management of acute lower extremity deep vein thrombosis(DVT)with iliac vein compression syndrome(IVCS).Methods A retrospective analysis of patients with acute DVT combined with IVCS,was conducted to compare the therapeutic efficacy and safety of one-stage or two-stage treatment of iliac vein stenosis.A total of 56 patients were included in this study.Twenty-one patients in one-stage treatment group simultaneously received iliac vein balloon dilatation(PTA)or stent implantation after percutaneous mechanical thrombectomy(PMT)or manual thrombus aspiration at the first procedure.Thirty-five patients in two-stage treatment group were treated with PMT or manual thrombus aspiration during the first operation,and iliac vein PTA or stent implantation was performed after catheter contact thrombolysis(CDT)as second-stage surgery.Patients in both groups were treated with inferior vena cava filter implantation.Results The time of CDT of patients in the one-stage treatment group was significantly shorter than that in the second-stage treatment group(P<0.001).Patients in the one-stage treatment group were treated with significantly lower doses of urokinase(P<0.001).The during time of hospital stay in one-stage treatment group was significantly shorter than that in the second-stage treatment group(P=0.009).The clinical symptom relief rate in the one-staged treatment group was significantly better(P=0.032).There was no significant difference in thrombosis clearance rate,venous patency pre-and post-treatment,thigh circumference,or calf circumference pre-and post-treatment(P>0.05).There was no significant difference in intraoperative blood loss or perioperative bleeding between the two groups(P>0.05).The difference between the venous patency rate or the Villalta score of the two groups was not statistically significant during the follow-up period(P>0.05).Conclusion The one-stage treatment of iliac vein stenosis is effective in treating acute DV

关 键 词：髂静脉压迫综合征 下肢深静脉血栓形成 一期治疗 

分 类 号：R654.4[医药卫生—外科学] R543.6[医药卫生—临床医学]