综合介入一体化治疗急性深静脉血栓形成合并髂静脉受压综合征的临床疗效分析  

Clinical efficacy analysis of integrated interventional therapy in acute deep venous thrombosis complicated with iliac vein compression syndrome

作　　者：李东起 秦红松[2] 王梦妍 郝清智[2] Li Dongqi;Qin Hongsong;Wang Mengyan;Hao Qingzhi(the First Clinical Medical College of Shandong University of Chinese Medicine,Ji'nan 250000,Shandong,China;Department of Peripheral Vascular Disease,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji'nan 250000,Shandong,China)

机构地区：[1]山东中医药大学第一临床医学院,山东济南250000 [2]山东中医药大学附属医院周围血管病科,山东济南250000

出　　处：《血管与腔内血管外科杂志》2022年第9期1038-1042,1076,共6页Journal of Vascular and Endovascular Surgery

基　　金：国家重点研发计划(2018YFC1704103);山东省中医药科技发展计划项目(2019-0969、2019-0971、2017-058);齐鲁尚德俊周围血管学术流派传承工作室。

摘　　要：目的探讨综合介入一体化治疗对急性深静脉血栓形成(DVT)合并髂静脉受压综合征(IVCS)的有效性和安全性。方法收集2019年3月至2021年9月于山东中医药大学附属医院接受综合介入一体化治疗的28例急性DVT合并IVCS患者的临床资料。分析技术成功率、静脉开通率、肿胀消除率。记录患者治疗过程中穿刺点出血、肺栓塞(PE)、消化道出血、肾功能损伤等并发症发生情况。治疗后1、3、6个月复查下肢静脉彩色多普勒超声,评估静脉血流通畅情况,观察下肢静脉回流受阻症状是否加重或复发及感觉或功能障碍的发生情况。结果28例患者均顺利完成综合介入一体化治疗,技术成功率为100%,静脉开通率>50%,其中,无Ⅲ级患者,Ⅱ级患者1例,27例患者静脉完全开通。治疗后24 h内肢体肿胀、疼痛症状明显减轻。治疗后72 h内肿胀消除率≥85.6%。治疗后,6例患者出现与抽吸相关的短暂性肉眼血红蛋白尿,但均未出现穿刺点出血、PE、消化道出血及肾功能损伤等并发症。治疗后1、3、6个月,所有患者均未复发下肢静脉回流受阻症状,静脉血流通畅。治疗后1个月,3例患者存在感觉或功能障碍。结论综合介入一体化治疗急性DVT合并IVCS安全有效,可有效防止栓子脱落进入肺脏,快速恢复静脉血液回流,尤其适用于高龄及出血风险较高的患者。Objective To explore the efficacy and safety of integrated interventional therapy for acute deep venous thrombosis(DVT)complicated with iliac vein compression syndrome(IVCS).Method The clinical data of 28 acute DVT patients complicated with IVCS who received integrated interventional therapy in Affiliated Hospital of Shandong University of Traditional Chinese Medicine from March 2019 to September 2021 were collected,and the success rate of surgery,venous patency rate and swelling elimination rate were analyzed.The occurrence of the bleeding of puncturing point,pulmonary embolism(PE),digestive tract bleeding,injury of kidney function during the treatment were recorded.After 1,3 and 6 months of treatment,the color Doppler ultrasound of lower limb vein was rechecked to evaluate the patency of venous blood flow,and observe whether the symptoms of lower limb vein reflux obstruction were aggravated or recurred,and the occurrence of sensory or dysfunction.Result All 28 patients successfully completed the integrated interventional therapy,with the technical success rate of 100%and the venous patency rate of more than 50%.Among them,there was no grade III patient,1 patient of grade II,and 27 patients had complete venous patency.The symptoms of limb swelling and pain were significantly relieved within 24 hours after treatment.The swelling elimination rate within 72 hours after treatment was≥85.6%.After treatment,6 patients had transient gross hemoglobinuria related to aspiration,but none had complications such as the bleeding of puncturing point,PE,digestive tract bleeding,injury of kidney function.All patients with acute DVT combined with IVCS had no symptoms of venous reflux obstruction of lower limbs,and venous blood flow was smooth at 1,3,and 6 months after treatment.One month after treatment,3patients had sensory or functional impairment.Conclusion Integrated interventional therapy for acute DVT complicated with IVCS is safe and effective,which can effectively prevent emboli from falling off into the lung and quickl

关 键 词：综合介入一体化治疗 急性深静脉血栓形成 髂静脉受压综合征 机械血栓抽吸技术 自膨式裸支架 

分 类 号：R543[医药卫生—心血管疾病]