一站式腔内介入治疗髂静脉压迫综合征继发下肢深静脉血栓疗效观察  

Efficacy of one-stop endovascular intervention in treatment of left iliac vein compression syndrome complicated with deep venous thrombosis of lower limbs

作　　者：姜广伟[1] 丁殿柱[1] 张晓宇[1] 牛帅[1] 吕柏楠[1] JIANG Guangwei;DING Dianzhu;ZHANG Xiaoyu;NIU Shuai;LYU Bonan(Department of Vascular Surgery,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院血管外科,河北石家庄050051

出　　处：《浙江大学学报（医学版）》2022年第3期341-349,共9页Journal of Zhejiang University(Medical Sciences)

基　　金：河北省医学科学研究计划(20190383)。

摘　　要：目的:探讨一站式腔内介入治疗髂静脉压迫综合征(IVCS)继发下肢深静脉血栓(DVT)临床效果及安全性。方法:回顾性分析2018年1月至2021年12月于河北省人民医院血管外科因左侧IVCS继发DVT入院治疗的26例患者的资料,均采用超声引导下膝下深静脉穿刺、Angiojet导管吸栓、髂静脉球囊扩张及支架植入、同期滤器取出的一站式腔内介入治疗,记录手术时间和导管吸栓时间;观察手术前后左下肢深静脉通畅度评分、健患肢膝上15 cm和膝下10 cm周径差,以及手术前后1 d血红蛋白量、肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、间接胆红素水平变化。通过随访,评价血栓后综合征发生率及髂静脉支架通畅情况。结果:26例患者均成功实施一站式腔内介入治疗,手术时间为(171±35)min,吸栓时间为(263±89)s。与手术治疗前相比,手术治疗后静脉通畅度评分、健患肢膝上及膝下周径差均减小(均P<0.01);血红蛋白量减少,肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素及间接胆红素水平均上升(均P<0.01)。患者随访时间为1~12个月,其中1例患者7个月后出现支架内血栓形成,经保守治疗后症状改善;1例患者存在支架内附壁血栓形成,支架内血流无影响;其余患者均支架通畅。所有患者随访期间未见血栓后综合征。结论:一站式腔内介入治疗IVCS合并左下肢DVT安全可行,治疗过程中须关注导管吸栓所致的肝肾功能指标的变化,及时给予相应干预,避免相关并发症发生。Objective:To evaluate the clinical effect and safety of one-stop endovascular intervention in treatment of left iliac vein compression syndrome(IVCS)complicated with deep venous thrombosis(DVT)of lower limbs.Methods:Clinical data of 26 patients with secondary DVT due to IVCS admitted in the Department of Vascular Surgery,Hebei General Hospital from January 2018 to December 2021 were retrospectively analyzed.All patients underwent one-stop endovascular intervention procedure,including ultrasound-guided deep venipuncture,Angiojet catheter aspiration,iliac vein balloon dilation,stent implantation and simultaneous filter retrieval.The operation time and catheter aspiration time were documented;the preoperative and postoperative left lower extremity deep vein venous patency,circumferences of bilateral limbs at 15 cm above the knee and 10 cm below the knee,and the levels of hemoglobin,creatinine,alanine aminotransferase(ALT),aspertate aminotransferase(AST),total bilirubin and indirect bilirubin were measured.The incidence of post-thrombotic syndrome(PTS)and iliac vein stent patency were recorded through follow-up.Results:The one-stop endovascular intervention was successfully performed in 26 patients,with the operation time of(171±35)min and the thrombolysis time of(263±89)s.After treatment,the left lower extremity deep vein venous patency,circumferences of bilateral limbs at 15 cm above the knee and 10 cm below the knee were decreased(all P<0.01);the hemoglobin level were decreased,the creatinine,ALT,AST,total bilirubin and indirect bilirubin levels were increased(all P<0.01).Patients were followed up for 1-12 months.Stent thrombosis occurred in 1 patient 7 months after procedure,and the symptoms were improved after conservative treatment;the stents were unobstructed in all patients,1 patient had stent mural thrombosis,in whom the stent blood flow was not affected.No PTS was observed during the follow-up.Conclusions:The one-stop endovascular interventional treatment of IVCS complicated with DVT of left lower limb is

关 键 词：髂静脉压迫综合征 深静脉血栓形成 导管吸栓 支架植入 疗效 安全性 

分 类 号：R654.4[医药卫生—外科学]