导管溶栓联合支架治疗髂静脉病变型急性下肢深静脉血栓形成术后血栓后综合征的观察  

Post-thrombotic syndrome after catheter thrombolysis combined with stent implantation for acute deep venous thrombosis of the lower extremity with iliac vein lesion

作　　者：张小涛 高涌[2] 卢冉[2] 武子赋 Zhang Xiaotao;Gao Yong;Lu Ran;Wu Zifu(Department of Vascular Surgery,Lixin County People's Hospital,Bozhou 236700,China;Department of Vascular Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]利辛县人民医院血管介入科,亳州236700 [2]蚌埠医学院第一附属医院血管外科,蚌埠233004

出　　处：《中华解剖与临床杂志》2023年第6期395-399,共5页Chinese Journal of Anatomy and Clinics

基　　金：安徽省自然科学基金(KJ2019A0327)。

摘　　要：目的探讨采用导管溶栓联合支架治疗的髂静脉病变型急性下肢深静脉血栓形成(DVT)患者术后血栓后综合征(PTS)的发生情况。方法横断面研究。纳入2019年3月—2020年7月利辛县人民医院及蚌埠医学院第一附属医院经导管溶栓联合支架治疗的61例髂静脉病变型急性下肢DVT患者的临床资料。其中,男20例、女41例,年龄24~75(55.7±11.7)岁,合并高血压4例、糖尿病5例。随访患者术后不良事件及并发症的发生情况,术后6、12、24个月采用静脉临床严重程度评分(VCSS)及Villalta量表评分评估术后2年内PTS的发生率和严重程度,同期复查髂静脉支架有无再狭窄发生。结果患者手术均顺利完成,61例患者共置入支架68枚。患者术后均随访2年以上(24.5~30.2个月),无死亡及肺动脉栓塞、严重出血,随访24个月中无其他不良事件发生。出院随访期间,6例患者并发轻微出血,16例患者发生PTS。术后6、12、24个月,患者Villalta评分结果显示PTS发生率分别为6.56%(4/61,4例轻度)、14.75%(9/61,8例轻度、1例中度)、26.23%(16/61,14例轻度、2例中度);VCSS评分分别为(3.64±1.21)、(4.62±1.36)、(5.62±1.75)分。术后6、12、24个月VCSS评分、PTS发生率差异均有统计学意义(F=66.36、χ^(2)=18.17,P值均<0.001)。术后2例中度PTS患者发生髂静脉支架内狭窄,髂静脉支架2年内通畅率为96.72%(59/61)。结论导管溶栓联合支架治疗髂静脉病变型急性下肢DVT,患者2年内的近、中期PTS发生率较低,但随着观察时间延长PTS严重程度有所进展,需要持续关注。Objective This study aimed to investigate the incidence of post-thrombotic syndrome(PTS)in patients with acute deep venous thrombosis of the lower extremity with iliac vein lesions treated by catheter-directed thrombolysis combined with stent implantation.Methods A cross-sectional study was conducted.Clinical data of 61 patients with acute deep venous thrombosis of the lower extremities with iliac vein lesions treated by transcatheter thrombolysis combined with stent in Lixin People's Hospital and the First Affiliated Hospital of Bengbu Medical College were included in this study.Of the 61 patients,20 were males and 41 were females,aged 24−75(55.7±11.7)years,including four cases with hypertension and five cases with diabetes mellitus.The incidence and severity of PTS were assessed by using the Venous Clinical Severity Score(VCSS)and Villalta scale at 6,12,and 24 months after operation,and the incidence of restenosis of iliac vein stent was re-examined simultaneously.Results The operation was successfully performed in all patients,and 68 stents were implanted in 61 patients.All patients were followed up for more than 2 years(24.5−30.2 months).No postoperative death,pulmonary embolism,severe bleeding,and other adverse events occurred during follow-up for 24 months.During discharge follow-up,six patients had minor bleeding,and 16 patients had PTS.The Villalta score showed that the incidence of PTS was 6.56%(4/61,four mild cases),14.75%(9/61,eight mild cases and one moderate case),and 26.23%(16/61,14 mild cases and two moderate cases),and the VCSS was 3.64±1.21,4.62±1.36,and 5.62±1.75,respectively.VCSS and PTS were significantly different at 6,12,and 24 months(F=66.36,χ^(2)=18.17,respectively;all P values<0.001).The iliac vein stenosis occurred in two patients with moderate PTS,and the patency rate of iliac vein stent was 96.72%(59/61)within 2 years.Conclusion Catheter thrombolysis combined with stent therapy for acute deep venous thrombosis of the lower extremities in patients with iliac vein disease has a

关 键 词：血栓形成后综合征 机械溶栓 导管溶栓 髂静脉 急性下肢深静脉血栓形成 

分 类 号：R654.3[医药卫生—外科学]