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复合手术治疗左髂静脉受压综合征继发左下肢急性深静脉血栓 预览 被引量:4

Hybrid operation for acute left leg deep venous thrombosis secondary to left iliac vein compression syndrome: analysis of 36 cases
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摘要 目的探讨复合手术治疗左髂静脉受压综合征(IVCS)继发左下肢急性深静脉血栓(LDVT)的操作要点和疗效。方法36例IVCS继发急性LDVT,予以下腔静脉滤器植入后,2例术中明确为IVCS合并陈旧性LDVT急性发作,放弃左髂静脉支架置人术。34例经左股静脉切开,以Fogarty上行取栓,远心端序贯挤压取栓。2例予以覆膜支架,32例予以裸支架植人髂总静脉。术后常规抗凝溶栓,动态监测患肢周径、D-二聚体、血清纤维蛋白原(FBG)和血管通畅情况。结果2例髂静脉支架展开不良行球囊扩张后残留血栓经裸支架挤入管腔中,予以接触溶栓5~7d;1例裸支架向后移位予以再次支架纠正;3例因溶栓致FBG下降出现自限眭出血。34例取栓患者治疗第3、6、30和180天患肢周径与治疗前存在统计学差异(踝上5cm:F=3.060,P=0.030;膝下10em:F=3.114,P=-0.028;膝上10cm:F=2.961,P=0.034),治疗第3、6、30和180天的D.二聚体水平与治疗前有显著差异(F=3.869,P=0.011),治疗第3、6、30和180天的FBG水平与治疗前比较无统计学差异(F=1.163,P=0.345),总显效率8313%(26/34),总有效率91.2%(31/34)。结论针对IVCS合并急性LDVT,尽可能地取净血栓恢复血流通道后,以支架径向支撑狭窄或闭塞的髂总静脉,具有可行性。 Objective To evaluate the surgical techniques for acute left deep venous thrombosis (LDVT) secondary to left iliac vein compression syndrome (IVCS). Methods Thirty-six patients with acute LDVT secondary to WCS received inferior vena cava filter placement, and in 2 of the cases, stent implantation was canceled for acute episode of obsolete DVT. The remaining 34 patients underwent left femoral venotomy for iliofemoral thrombectomy with Fogarty catheter and distal femoral vein thrombus removal by sequential compression of the legs, followed by implantation of stent-graft (2 cases) or bare-metal stents (32 cases) in the left common iliac veins. With routine anticoagulation and thrombolytic treatments, the patients were regularly examined for postoperative blood flow in the affected limb. Results In 2 of the cases undergoing bare-metal stent implantation, the residue thrombi were squeezed into the stent by balloon, which was managed subsequently with local thrombolysis. One patient with bare-metal stent implantation received a secondary stenting for posterior stent displacement. Three patients had self-limited bleeding due to decreased serum FBG. Significant improvements were achieved at 3, 6, 30 and 180 days postoperatively in the circumferences of the affected limb (P〈0.05) and in the levels of D-dimer (P=0.011), and FBG level showed no significant variations (F=1.163, P=0.345). The total rate of excellent outcomes was 83.3% (26/34) with a total effective rate of 91.2% (31/34) in these cases. Conclusions Thrombectomy to revascularize the inflow tract and stent implantation to enlarge stenosed iliac veins are key issues in treatment of acute LDVT secondary to IVCS.
作者 周忠信 符方勇 林智琪 潘春球 ZHOU Zhongxin1, FU Fangyong, LIN Zhiqi, PAN Chunqiu2 Department of Vascular Surgery1, Department of Emergency2, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
出处 《南方医科大学学报》 CAS CSCD 北大核心 2013年第1期131-134,共4页 Journal of Southern Medical University
基金 广东省科技计划项目(20118061300022) 广东省医学科研基金(A2012356)
关键词 左髂静脉受压综合征 深静脉血栓 血栓切除术 复合手术 iliac vein compression syndrome deep venous thrombosis lower limbs thrombectomy hybrid operation
作者简介 周忠信,主治医师,020-62787963,E-mail:zhoujohnson001@yahoo.com.cn
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参考文献13

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