22例急性下肢深静脉血栓形成的外科治疗体会

目的探讨急性下肢深静脉血栓形成的手术方法。方法选择下肢深静脉血栓发病7d内患者22例，经股静脉切开取栓，由大隐静脉侧支留置导管，术后溶栓治疗及造影检查。结果全部患者于术后3d内肿胀缓解，序贯溶栓治疗10d后，症状完全消失。2例留置导管脱落，20例拔管前造影显示：12例患者左髂静脉狭窄或闭塞，陈旧性血栓附壁，大量侧支循环建立，髂静脉内无新鲜血栓。随访20例，随访时间3～36月，平均12个月，仅2例发生血栓后综合征。结论手术治疗急性下肢深静脉血栓形成疗效肯定，左髂静脉狭窄或闭塞虽然是左下肢深静脉血栓形成的重要因素，术中同期处理狭窄或闭塞手术较复杂、费时，有较多并发症。笔者采用取栓后序贯溶栓治疗，效果优良。左髂静脉狭窄或闭塞，术后若无症状可不予处理或二期处理。

Surgical Treatment of Acute Thrombosis in Deep Veins of Lower Limb

Objective To explore the surgical method for the acute deep vein thrombosis of lower limb. Methods We chosen 22 patients with lower limb deep venous thrombosis in seven days,and then took out thrombus through the femoral vein incision, indwelled catheter by the collateral of great saphenous vein, and performed postoperative thrombolytic therapy and contrast examination. Results The swellings in all patients were eased within 3 days after the operation, then the symptoms disappeared completely after 10 days of sequential thrombolytic therapy, two cases of indwelling catheter fell off. The angiography of 20 patients before extubation showed that 12 patients were with stenosis or obstruction of left iliac venous, old mural thrombosis, a large number of collateral circulation, and no fresh iliac vein thrombosis. 3 to 36 months follow up（ average 12 months ） showed that the postthrombotic syndrome occurred in 2 cases （2/20）. Conclusion The effect of the surgical treatment is fine for acute lower limb deep venous thrombosis. Although the left iliac venous stenosis or obstruction is one of the essential factors contributing to left lower extremity deep venous thrombosis（DVT） of left lower extremity, but the surgery in dealing with them is trouble, time-consuming, and more complications in the same period. We have taken sequential thrombolytic therapy after thrombectomy and the effect is fine. The Left common iliac vein stenosis or occlusion without symptoms may be leaved along or performed the secondary treatment.