经皮机械性血栓清除联合支架植入治疗髂静脉狭窄合并下肢深静脉血栓形成的中远期疗效  

Medium-and long-term efficacy of percutaneous mechanical thrombectomy with stent implantation in patients with iliac vein stenosis and thrombosis

作　　者：陈春伦 邱宸阳 沈兰 朱人大[4] 周华吉 张鸿坤[1] CHEN Chunlun;QIU Chenyang;SHEN Lan;ZHU Renda;ZHOU Huaji;ZHANG Hongkun(Department of Vascular Surgery,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Vascular Surgery,the Second Hospital of Jiaxing Affiliated to Jiaxing University,Jiaxing 314000,Zhejiang Province,China;Department of Vascular Surgery,the First Hospital of Jiaxing Affiliated to Jiaxing University,Jiaxing 314001,Zhejiang Province,China;Department of Vascular Surgery,Haining People’s Hospital,Jiaxing 314400,Zhejiang Province,China;Department of Vascular Surgery,the No.1 People’s Hospital of Pinghu,Jiaxing 314200,Zhejiang Province,China)

机构地区：[1]浙江大学医学院附属第一医院血管外科,浙江杭州310003 [2]嘉兴大学附属嘉兴市第二医院血管外科,浙江嘉兴314000 [3]嘉兴大学附属嘉兴市第一医院血管外科,浙江嘉兴314001 [4]海宁市人民医院血管外科,浙江嘉兴314400 [5]平湖市第一人民医院血管外科,浙江嘉兴314200

出　　处：《浙江大学学报(医学版)》2025年第1期108-114,共7页Journal of Zhejiang University(Medical Sciences)

基　　金：嘉兴市科技计划(2021AD30092)。

摘　　要：目的:观察经皮机械性血栓清除(PMT)联合髂静脉支架植入治疗髂静脉狭窄合并下肢深静脉血栓形成的中远期疗效。方法:收集2017年1月至2021年6月于浙北地区五家三级医院血管外科接受PMT联合髂静脉支架植入治疗的髂静脉狭窄合并下肢深静脉血栓形成总计125例患者的临床资料及随访信息,统计下肢血栓清除率、患肢血栓复发率、支架通畅率、下肢血栓后综合征(PTS)发生率,以及安全性评估指标如出血、死亡、肺栓塞、支架折断和移位等。结果:125例患者中,下肢血栓清除程度Ⅰ级8例(6.4%),Ⅱ级10例(8.0%),Ⅲ级107例(85.6%)。中位随访时间为74个月,12、24、36个月患肢血栓复发率分别为8.48%、8.93%和10.91%,髂静脉支架通畅率分别为91.52%、91.07%和89.09%,PTS发生率分别为5.08%、5.36%和6.36%,且均为轻度PTS。未出现如死亡、大面积肺栓塞及严重肝肾功能不全等重大安全性事件,未出现因支架折断等特殊情况再次入院干预事件。结论:PMT联合髂静脉支架植入能迅速清除髂静脉狭窄合并下肢深静脉血栓形成患者的下肢深静脉血栓,恢复下肢静脉血流,中远期支架通畅率高,PTS发生率低,安全性较高。Objective:To investigate the medium-and long-term efficacy of percutaneous mechanical thrombectomy(PMT)combined with stent implantation for treatment of iliac vein stenosis with lower extremity deep venous thrombosis(LEDVT).Methods:Clinical and follow-up data of 125 patients with iliac vein stenosis and LEDVT who underwent PMT and stent implantation at five hospitals in northern Zhejiang province from January 2017 to June 2021 were collected.The thrombus clearance rate,thrombus recurrence rate,patency rate of iliac vein stents and postthrombotic syndrome(PTS)occurrence rate were documented,and safety indicators such as bleeding,death,pulmonary embolism,stent fracture and displacement were assessed.Results:Among 125 patients,for clearance of limb thrombosis,there were 8 cases of gradeⅠ(6.4%),10 cases of gradeⅡ(8.0%),and 107 cases of gradeⅢ(85.6%).Patients were followed up for a median period of 74 months.According to the Villalta score,the recurrence rates of limb thrombosis at 12,24 and 36 months were 8.48%,8.93%and 10.91%;the iliac vein patency rates were 91.52%,91.07%,and 89.09%;and the incidences of PTS were 5.08%,5.36%and 6.36%,respectively.There were no major adverse events such as death,massive pulmonary embolism or severe hepatic and renal insufficiency,and no readmission intervention events due to stent fracture or other incidence were found.Conclusion:PMT combined with iliac vein stent implantation is effective for patients with iliac vein stenosis complicated by LEDVT with good mediumand long-term efficacy and safety,which is worthy of clinical application.

关 键 词：经皮机械性血栓清除 支架植入 髂静脉压迫综合征 下肢深静脉血栓形成 下肢血栓后综合征 疗效 

分 类 号：R654[医药卫生—外科学]