下肢深静脉血栓后综合征患者中静脉支架的中期通畅率及高危因素回归分析  

Mid-term patency of venous stent in patients with deep venous post-thrombotic syndrome of the legs and regression analysis of high risk factors

作　　者：汪涛 范隆华 刘坚军 李旭 陶悦 王晓俊 黎力梦 董智慧 WANG Tao;FAN Long-hua;LIU Jian-jun;LI Xu;TAO Yue;WANG Xiao-jun;LI Li-meng;DONG Zhi-hui(Department of Vascular Surgery,Qingpu Branch of Zhongshan Hospital,Fudan University,Shanghai 201700,China;Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院青浦分院血管外科,上海201700 [2]复旦大学附属中山医院血管外科,上海200032

出　　处：《复旦学报（医学版）》2022年第3期339-344,共6页Fudan University Journal of Medical Sciences

基　　金：上海市卫健委青年项目(20194Y0286);复旦大学附属中山医院青浦分院青年项目(QY2019-02);上海市卫健委面上项目(202140227,202040062);上海市青浦区卫健委基础项目(W2020-11)。

摘　　要：目的探索下肢深静脉血栓后综合征(post-thrombotic syndrome,PTS)患者中静脉支架的中期通畅率及高危因素回归分析。方法对2015年8月至2019年3月在复旦大学附属中山医院青浦分院就诊的124例PTS患者随访2年,所有患者均接受髂股静脉球囊扩张联合支架植入术,术后根据指南行规范抗凝治疗。最终纳入102例PTS患者,统计术后支架通畅率,采用Logistic回归分析影响支架通畅率的高危因素。结果植入支架技术成功率为100%,术后即可临床缓解率93.1%。随访2年静脉支架通畅率为85.3%。肥胖(OR=1.999,95%CI:1.145~3.489)、未规范抗血小板治疗(OR=0.050,95%CI:0.003~0.932)、长段支架(OR=41.033,95%CI:1.346~1250.940)和未予弹力袜支持治疗(OR=0.018,95%CI:0.001~0.622)是影响PTS患者术后支架通畅率的主要危险因素。结论静脉支架植入是治疗下肢PTS的有效治疗措施,术中采用短支架、术后抗血小板治疗、弹力袜支持以及肥胖患者术后2年内减肥,可增加支架中期通畅率。Objective To explore the mid-term patency of venous stent and high risk factors on deep venous post-thrombotic syndrome(PTS)of the legs.Methods From Aug 2015 to Mar 2019,124 patients with PTS treated in Qingpu Branch of Zhongshan Hospital,Fudan University were followed up for 2 years.All patients received balloon angioplasty and implantation of iliac-femoral venous stent therapy.Standard anticoagulant therapy was used after intervention operation.Finally,102 patients participated in the study,the patency of the stent was counted and high-risk factors were evaluated by Logistic regress analysis.Results The successful rate of stent implantation was 100%,and the clinical remission rate was 93.1%after the operation.The patency of the stent was 85.3%within 2 years.Obesity(OR=1.999,95%CI:1.145-3.489),informal antiplatelet therapy(OR=0.050,95%CI:0.003-0.932),long stent(OR=41.033,95%CI:1.346-1250.940)and informal elastic support stocking therapy(OR=0.018,95%CI:0.001-0.622)were the major risk factors for stent patency in PTS patients.Conclusion The venous stent implantation is an effective treatment for PTS of the legs.Short stent and treatment of antiplatelet,elastic support stocking therapy and weight loss within 2 years after operation in obese patients may help to increase the mid-term patency of venous stent.

关 键 词：静脉支架 血栓后综合征(PTS) 通畅率 高危因素 

分 类 号：R654.3[医药卫生—外科学]