左髂静脉压迫综合征的外科治疗

目的 探讨对左髂静脉压迫综合征患者外科处理的适应证、手术方法和围手术期的处理经验。方法 左下肢静脉曲张或慢性肿胀46例,行介入治疗32例,进腹行髂静脉松解、右髂动脉后置吻合8例,髂静脉病变段切除、人工血管原位移植6例,同时或二期手术处理大隐静脉及股静脉瓣膜41例。急性左下肢深静脉血栓形成36例,取栓后行左髂静脉病变段切除、人工血管原位移植25例,髂一下腔静脉搭桥11例。随访6～66个月。结果 无手术死亡和急性肺动脉栓塞发生。效果良好。结论 左髂静脉病变是左下肢静脉曲张或肿胀和急性左下肢深静脉血栓形成的重要原因,应尽早处理。介入治疗或外科手术治疗能取得良好的效果。

Surgical treatment of left iliac compression syndrome

Objective To explore the remedial indications, operational methods, and perioperational treatment of iliac compression syndrome (ICS) in left extremity. Methods The clinical data of 46 patients with symptoms of chronic swelling or varicose vein in left lower extremity and the diagnosis of left ICS were analyzed. Interventional treatment, iliac vein loosening by laparotomy and right iliac artery anastomosis behind left iliac vein lesion, and vascular graft orthotopic transplantation were performed in 32, 8 and 6 cases respectively. Surgical management of saphenous vein and femoral valves were performed simultaneously or by secondary operation in 41 cases. 36 patients were complicated by acute left lower extremity deep venous thrombosis (DVT), of which resection of lesion in left iliac vein and vascular graft orthotopic transplantion after thrombectomy, and iliocaval bypass were performed in 25 and 11 cases respectively. After treatment, the patients were followed up for 6-66 months. Results No operation death and acute pulmonary embolism was found among the patients. The treatrment showed a good long term effect. Conclusion Lesions of left iliac vein are the important cause of swelling and varicose veins and acute DVT in left lower extremity and should be managed as early as possible. Interventional treatment and surgery are effective.