摘要
目的探讨置管溶栓后、一期行髂静脉球囊扩张(或同时支架置入)在Cockett综合征继发急性左下肢深静脉血栓形成治疗中的意义。方法回顾性收集2016年1月至2019年6月期间笔者所在科室收治的41例Cockett综合征继发急性左下肢深静脉血栓形成患者的临床资料。所有患者在滤器保护下行导管接触性溶栓治疗,溶栓后造影检查存在髂静脉梗阻者,同时行球囊扩张或联合支架置入。比较患者治疗前后的健患肢髌骨上、下缘15 cm的大小腿周径,并分析静脉通畅率。结果本组患者溶栓导管的放置时间为(7±3)d,尿激酶用量为(358.32±69.38)×104 U。本组共置入35枚巴德支架(35例),4例行球囊扩张,2例放弃治疗。治疗前后健患肢大腿周径差、小腿周径差及静脉通畅评分比较,差异均具有统计学意义(P<0.01)。本组患者的静脉通畅率为58%~75%、(61±10)%,术后无严重出血并发症发生。治疗后35例患者获得随访,随访时间3~26个月,瓣膜保存率达82.86%(29/35),髂静脉一期通畅率为100%(39/39)。随访期间1例髂静脉闭塞未处理者血栓复发,1例患者因髂静脉支架进入下腔静脉过长,导致右侧急性血栓形成;无肺栓塞病例。结论在导管溶栓基础上,一期解除髂静脉梗阻治疗急性左下肢深静脉血栓形成,能够及时缓解患者的临床症状,降低血栓复发率,减少深静脉血栓形成后综合征的发生。
Objective To investigate the significance of catheter thrombolysis combined with one-stage iliac vein percutaneous transluminal angioplasty(or stent implantation)in the treatment of acute left lower extremity deep venous thrombosis secondary to Cockett syndrome.Methods Forty-one cases of Cockett syndrome complicated with acute left lower extremity deep vein thrombosis were retrospectively analyzed and summarized in our hospital from January 2016 to June 2019.Catheter directed thrombolysis was performed under the protection of filter,and percutaneous transluminal angioplasty or stent implantation was performed in the first stage of the iliac vein stenosis or occlusion after thrombolysis.Compared the circumference of upper and lower legs of 15 cm above and below patella of the healthy and affected limbs,before and after treatment,and analyzed the venous patency rate.Results The average time of using thrombolytic catheter were(7±3)days,and the average dosage of urokinase was(358.32±69.38)×104 U.A total of thirty-five Bard stents were implanted(35 cases),four cases underwent percutaneous transluminal angioplasty,and two cases gave up treatment.Before and after treatment,the circumference difference of the higher leg,the circumference difference of the lower leg,and the venous patency were significantly different before and after thrombolysis(P<0.01).The venous patency rate was 58%–75%in this group,and the average venous patency rate was(61±10)%.There was no severe bleeding complication occurred.Thirty-five patients were followed up for 3–26 months,the preservation rate of the valve was 82.86%(29/35),and the first patency rate of iliac vein was 100%(39/39).During the follow-up period,thrombosis recurred in one case of untreated iliac vein,and acute thrombosis in the right side of one case was caused by long iliac vein stent entering the inferior vena cava.No pulmonary embolism was found.Conclusion On the basis of catheter thrombolysis,one stage removal of iliac vein obstruction in the treatment of acute left lower extremity deep venous thrombosis can relieve the clinical symptoms,reduce the recurrence rate of thrombosis,and reduce the occurrence of deep vein thrombosis syndrome after catheter thrombolysis.
作者
孙振阳
芮清峰
SUN Zhenyang;RUI Qingfeng(Department of Vascular Surgery,Fuyang No.2 People’s Hospital,Fuyang,Anhui 236015,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2019年第12期1440-1444,共5页
Chinese Journal of Bases and Clinics In General Surgery
