手术取栓联合腔内介入治疗急性深静脉血栓的临床分析

目的 总结手术取栓联合腔内介入治疗急性髂股深静脉血栓(DVT)的临床经验.方法 2008年10月至2010年12月,15例急性DVT患者接受手术取栓联合同侧髂静脉腔内支架植入术.男性6例,女性9例;年龄36～71岁,平均57.4岁.DVT位于左股、髂及下腔静脉内2例,双侧髂静脉1例,其余12例均在左髂股静脉.所有患者表现患肢明显肿胀,其中12例伴有患肢疼痛.DVT发病时间平均为3.3 d.诱发DVT的原因包括外科手术6例,DVT复发2例,其余7例病因不清.并发症包括消化道出血1例,胃溃疡1例,高血压3例,脑梗死1例.取栓之前均先经右股静脉穿刺植入下腔静脉滤器(包括1例双髂静脉血栓患者),取栓之后术中造影均发现髂静脉受压致重度狭窄或完全闭塞,均先行球囊血管成形后植入自膨式支架.结果 术中造影证实髂静脉压迫综合征12例,取栓后残留狭窄3例.共植入18枚自膨式支架,手术成功率15/15,30 d病死率为0;1例术后伤口出现血肿,保守治疗后痊愈.12例获得随访,随访时间为2～26个月,平均13.3个月.所有患者疼痛消失,仅2例表现为活动后患肢轻度肿胀.所有患者均未出现血栓复发.结论 手术取栓联合腔内介入治疗急性DVT安全有效,早期临床结果满意,并发症发生率低.     

手术取栓联合腔内介入治疗急性深静脉血栓的临床分析

目的 总结手术取栓联合腔内介入治疗急性髂股深静脉血栓(DVT)的临床经验.方法 2008年10月至2010年12月,15例急性DVT患者接受手术取栓联合同侧髂静脉腔内支架植入术.男性6例,女性9例;年龄36～71岁,平均57.4岁.DVT位于左股、髂及下腔静脉内2例,双侧髂静脉1例,其余12例均在左髂股静脉.所有患者表现患肢明显肿胀,其中12例伴有患肢疼痛.DVT发病时间平均为3.3 d.诱发DVT的原因包括外科手术6例,DVT复发2例,其余7例病因不清.并发症包括消化道出血1例,胃溃疡1例,高血压3例,脑梗死1例.取栓之前均先经右股静脉穿刺植入下腔静脉滤器(包括1例双髂静脉血栓患者),取栓之后术中造影均发现髂静脉受压致重度狭窄或完全闭塞,均先行球囊血管成形后植入自膨式支架.结果 术中造影证实髂静脉压迫综合征12例,取栓后残留狭窄3例.共植入18枚自膨式支架,手术成功率15/15,30 d病死率为0;1例术后伤口出现血肿,保守治疗后痊愈.12例获得随访,随访时间为2～26个月,平均13.3个月.所有患者疼痛消失,仅2例表现为活动后患肢轻度肿胀.所有患者均未出现血栓复发.结论 手术取栓联合腔内介入治疗急性DVT安全有效,早期临床结果满意,并发症发生率低.     

手术取栓联合腔内介入治疗急性深静脉血栓的临床分析

目的 总结手术取栓联合腔内介入治疗急性髂股深静脉血栓(DVT)的临床经验.方法 2008年10月至2010年12月,15例急性DVT患者接受手术取栓联合同侧髂静脉腔内支架植入术.男性6例,女性9例;年龄36～71岁,平均57.4岁.DVT位于左股、髂及下腔静脉内2例,双侧髂静脉1例,其余12例均在左髂股静脉.所有患者表现患肢明显肿胀,其中12例伴有患肢疼痛.DVT发病时间平均为3.3 d.诱发DVT的原因包括外科手术6例,DVT复发2例,其余7例病因不清.并发症包括消化道出血1例,胃溃疡1例,高血压3例,脑梗死1例.取栓之前均先经右股静脉穿刺植入下腔静脉滤器(包括1例双髂静脉血栓患者),取栓之后术中造影均发现髂静脉受压致重度狭窄或完全闭塞,均先行球囊血管成形后植入自膨式支架.结果 术中造影证实髂静脉压迫综合征12例,取栓后残留狭窄3例.共植入18枚自膨式支架,手术成功率15/15,30 d病死率为0;1例术后伤口出现血肿,保守治疗后痊愈.12例获得随访,随访时间为2～26个月,平均13.3个月.所有患者疼痛消失,仅2例表现为活动后患肢轻度肿胀.所有患者均未出现血栓复发.结论 手术取栓联合腔内介入治疗急性DVT安全有效,早期临床结果满意,并发症发生率低.     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

目的 比较手术取栓与介入取栓治疗急性下肢深静脉血栓形成(DVT)的近、远期疗效.方法 回顾性分析2000年3月至2008年8月136例急性混合型和中心型DVT患者的临床资料.手术取栓组80例,其中男性30例,女性50例;年龄26-81岁,平均(58±14)岁.介入取栓组56例,其中男性25例,女性31例;年龄22～92岁,平均(57±17)岁.术后均局部应用尿激酶溶栓、肝素抗凝治疗,后期应用华法林抗凝6～12个月.结果 介入取栓组治疗后双大腿周径差小于手术取栓组[(0.8±1.3)cm比(1.5±1.7)cm,P=0.002],两组小腿周径差异无统计学意义[(0.7±1.1)cm比(1.0±1.1)cm,P=0.152].介入取栓组的平均住院时间少于手术取栓组[(7±4)d比(15 4-7)d,P=0.000].介入取栓组并发症发生率低于手术取栓组(8.9%比32.5%,P=0.000).108例获随访,随访率为79.4%.平均随访(46±29)个月,两组在大、小腿周径差、症状评分、色素沉着、静脉曲张、间歇性跛行及慢性溃疡的发生率等方面差异均无统计学意义(P>0.05).结论 介入取栓与手术取栓相比,远期疗效相当,近期疗效更佳,且住院时间短,并发症少.     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

取栓联合腔内血管成形术治疗急性下肢深静脉血栓形成

目的 探讨开放手术结合多种介入方法对急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的疗效.方法 本组521例(521条肢体),男356例,女165例.年龄16～86岁,平均(46±9)岁.均先经健侧安置下腔静脉滤器,再于患侧小切口解剖股静脉.行Fogarty导管取栓术.其中单纯取栓38例;取栓联合球囊导管血管成形术348例;血管成形联合血管腔内超声消融135例;支架置入108例.结果 手术成功511例,阻塞血管完全开通.其中除31例经造影未见血管狭窄,7例管腔直径＞90%而未行扩张治疗以外,365例狭窄段血管经球囊扩张后造影示静脉平均狭窄由90%±5%降低到24%±5%,108例狭窄段经扩张后残留管腔狭窄仍＞50%,置入相应大小裸支架;左髂总静脉开口未能开通10例.随访472例(90.6%),随访时间8～108个月,平均(53±26)个月.其中462例完全恢复正常或基本正常,可从事正常工作;10例髂静脉未开通者活动后肢体仍肿胀明显.发生并发症33例(6.3%).结论 取栓联合腔内血管成形术治疗DVT是一种安全、有效的方法.

Abstract：

Objective To evaluate a combination of open surgery and multiple interventional methods in the treatment of DVT of the lower extremities. Methods 521 cases (521 limbs,356 male and 165 female) were studied in this group. Age ranged from 16 to 86 years with the mean age of (46 ±9)years. All 521 cases with DVT were treated by Fogarty embolectomy catheter. Among them,348 cases underwent percutaneous transluminal angioplasty (PTA), 135 cases received PTA and ultrasound ablation,stent-grafts were implanted in 108 cases. Results Based on angiography during operation, the obstructed iliofemoral vein received complete recanalization in 511 cases. Among them, the postoperative luminal diameter was more than 90% in 38 cases after Fogarty embolectomy, the average stenosis rate was reduced from 90% ±5% to 24% ±5% in 365 cases after PTA and stent-grafts were implanted in 108 cases with the stenosis rate still over 50% after PTA. Only partial recanalization was achieved in the entrance of common iliac vein to inferior vena cava in 10 cases. Of the 521 cases,472 cases were followed-up with mean time of (53 ± 26) months, ranging from 8 to 108 months and 462 cases reported satisfactory results with normal life,the unsuccessful 10 cases still felt swelling pain especially in erect position. Complications occurred in 33 cases. Conclusions Open surgery combining with multiple interventional methods is a safe and effective method in the treatment of DVT.     

经导管取栓及溶栓治疗急性下肢深静脉血栓

目的探讨经导管取栓及溶栓技术治疗急性下肢深静脉血栓的临床价值及疗效。方法收集急性下肢深静脉血栓患者117例,其中中央型血栓71例,混合型血栓46例。在下腔静脉滤器保护下,对患者行经大腔导管取栓及溶栓导管溶栓治疗,对合并Cockett综合征者行支架成形治疗。结果手术成功率100%,患肢肿胀、疼痛于术后当日即明显减轻,无肺栓塞发生。110例患者均成功随访12个月,总有效率97.27%(103/110)。结论经导管取栓及溶栓治疗急性下肢深静脉血栓安全、有效。     

急性混合型下肢深静脉血栓取栓与溶栓远期疗效分析

目的 比较手术取栓与系统溶栓对急性混合型下肢深静脉血栓形成(DVT)的远期疗效.方法 回顾分析1991年9月至2005年6月的142例急性混合型DVT病例的临床资料.手术取栓77例,其中合并髂总静脉狭窄或闭塞49例,对于髂总静脉严重狭窄或闭塞者采取不同方法处理.手术后辅以区域性尿激酶溶栓、肝素抗凝治疗.系统溶栓65例,均系统性应用尿激酶、肝素.结果 治疗后2周,手术取栓组双下肢周径差由(4.3±2.2)cm降为(0.6±0.5)cm,系统溶栓组由(3.9±2.5)cm降为(1.6±0.9)cm,差异有统计学意义(t=-8.346,P=0.00).平均随访(49±42)个月,手术取栓组周径差降为(0.5±0.4)cm,系统溶栓组降为(1.4±1.3)cm(t=-5.764,P=0.00);手术取栓组水肿、色素沉着、溃疡等后遗症发生率分别为29.9%、15.6%、0%,低于系统溶栓组的50.8%、84.6%、6.2%(P＜0.05).彩超发现,手术取栓组静脉通畅率(89.6%)和瓣膜功能正常率(72.7%),均高于系统溶栓组(分别为30.8%、9.2%)(Z=-8.502,P=0.00).手术取栓组治愈率70.1%,高于系统溶栓组治愈率30.8%(Z=-4.740,P=0.00).手术组死亡率为3.9%,溶栓组无住院死亡率.结论 本组资料显示手术取栓对急性混合型DVT的疗效好于系统溶栓,尤其在保护静脉瓣膜功能方面明显优于系统溶栓;但手术创伤较大、有一定的死亡率.     

手术取栓与药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效比较

目的 评估手术取栓加药物溶栓与单纯药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效.方法 回顾性分析175例髂股型下肢深静脉血栓形成患者的临床资料,依据治疗方式的不同分为取栓组与溶栓组;手术取栓组85例,其中合并髂总静脉狭窄或闭塞的46例,选择于术或介入治疗,术后给予尿激酶、低分子肝素治疗.采取药物溶栓抗凝治疗90例,仪给予尿激酶、低分子肝素治疗.治疗前两组患者年龄、病程、肿胀程度及伴随疾病比较,差异无统计学意义(P＜0.05).结果 治疗后1个月,手术取栓组治愈率71.8%(61/85),双下肢周径差手术组由(4.6±1.6)cm下降为(0.8±0.5)cm;溶栓组治愈率38.9%(35/90);双下肢周径差由(4.0±1.9)cm下降为(1.8±1.3)cm.平均随访(28±11)个月,随访率64.6%,治疗后12个月,双下肢周径差手术组下降为(0.4±0.3)cm,溶栓组下降为(0.9±0.7)cm,手术组治愈率86.0%(49/57),溶栓组治愈率53.6%(30/56);手术组的下肢深静脉血栓形成后遗症发生率低于溶栓组(P＜0.05),手术组的静脉瓣功能异常的发生率低于溶栓组(P＜0.05).结论 急性髂股型下肢深静脉血栓形成手术取栓加溶栓疗效优于单纯药物溶栓.     

Cockett综合征继发急性下肢深静脉血栓形成的治疗

目的 比较手术取栓与导管溶栓治疗Cockett综合征继发急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的近、远期疗效.方法 回顾性分析2006年1月至2011年12月102例Cockett综合征继发急性DVT患者的临床资料.导管溶栓组(A组)52例,手术取栓组(B组)50例.术后均口服华法林抗凝至少6个月.结果 2组患者术前一般资料具有可比性.A组术后消肿率83％ ±6％,B组为82％±8％,A组静脉通畅率64.6％±6.7％,B组为65.3％±7.2％,差异均无统计学意义(均P＞0.05);A组平均手术时间少于B组[(30.5±6.7)min比(97.5±23.6) min,P＜0.01].A组平均住院时间少于B组[(9.8±5.4)d比(17.7±8.2)d,P＜0.01].A组并发症的发生率低于B组[13.4％比42％,P＜0.01].86例获随访,随访率84.3％.平均随访时间A组(18±8.7)个月,B组(16.8±10.2)个月,2组在大腿周径差、静脉通畅评分、后遗症发生率的方面差异均无统计学意义(均P＞0.05).结论 导管溶栓与手术取栓治疗DVT近、远期疗效相当.导管溶栓组住院时间短,并发症少.     

溃疡周围缝扎术治疗慢性阻塞性静脉功能不全并发的下肢溃疡

目的 探讨溃疡周围缝扎术在治疗严重阻寒性静脉功能不全并发下肢溃疡中的作用.方法 临床收治32例阻塞性静脉功能不全并发溃疡患者随机分为两组,每组16例,对照组行常规物理治疗及药物治疗;缝扎组在常规物理治疗及药物治疗外加行溃疡周围缝扎术.记录观察治疗前后主要的临床和实验室指标,分析组间差异. 结果治疗后局部反流交通支缝扎组(1.0±0.8)支,对照组(2.5±1.2)支,两组差异有统计学意义(P=0.001).静脉血氧分压(39±7)mm Hg,对照组(32±6)mm Hg,两组差异有统计学意义(P=0.005),治疗后溃疡部位经皮氧分压缝扎组(71±12)mm Hg,对照组(63±11)mm Hg.两组差异有统计学意义(P=0.007).缝扎组治疗后线粒体数量增多,局部浸润白细胞减少,粗面内质网形态正常.溃疡愈合时间(12±6)d,复发率12.5%,两组差异有统计学意义(P<0.05).结论 周围缝扎术可减轻阻塞性静脉功能不全并发溃疡局部血流淤滞、炎性细胞浸润,改善组织营养状况及氧供,缩短溃疡愈合时间,对静脉阻塞性溃疡是一种简便、有效的治疗方法,与常规物理治疗联用可降低复发率.     

介入联合手术治疗急性下肢深静脉血栓形成

目的 探讨急性下肢深静脉血栓形成介入联合手术治疗方法.方法 2002年1月至2004年12月对42例急性下肢深静脉血栓形成患者,首先经健侧股静脉置入下腔静脉滤器,再切开患侧股静脉,远端血栓以挤压法驱出,近端髂静脉内血栓以Fogarty导管取出,球囊扩张左髂静脉狭窄,最后做临时性股动静脉瘘,术后3个月结扎.结果 40例治疗成功,37例髂静脉狭窄,7例放置支架;随访34例,3～32个月.26例患肢肿胀消失,8例有不同程度的下肢肿胀,4例复发,随访时血管造影20例,14例血管形态良好,3例呈血栓后综合征表现,3例血管闭塞.结论 本方法创伤小,恢复快,疗效好,多数患者能耐受.     

血栓消融、溶栓和取栓对犬股静脉壁形态学影响的研究

目的　比较Amplatz血栓消融术 (Amplatzthrombectomydevice ,ATD)、溶栓 (thromboly sis,TL)及外科取栓 (thrombectomy ,TX)治疗犬急性股静脉血栓形成后静脉壁形态学变化。 方法36只成年杂种犬制作成股静脉血栓模型后随机分为 3组 ,每组 12只。另 4只假手术 ,作对照组。结果 3组均能有效地清除血栓。ATD、TL、TX组 1周静脉通畅率分别为 75 %、33%、2 5 % (P <0 0 5 )。TX组内膜增生最严重。ATD组胶原染色面积百分比较TX和TL组少 (P <0 0 1)。 1周时ATD及TL组内皮损伤较TX组轻 (P <0 0 5 )。结论ATD治疗犬急性股静脉血栓形成具有良好的近期效果。ATD及TL具有同样的内皮结构保护作用。     

下肢深静脉血栓形成165例的治疗分析

目的：观察下肢深静脉血栓形成(DVT)患者手术取栓和药物溶栓治疗的疗效。方法：对165例(175侧)下肢DVT患者进行总结。其中64例采用Fogarty导管取栓，101例采用药物溶栓治疗。结果：全组96例患者得到随访，随访率为58．2％，随访时间7--218个月，平均71个月。44例为手术取栓，52例为药物溶栓。随访发现症状完全消失取栓组占20．5％(9／44)，高于溶栓组13．5％(7／52)，溶栓组肢体发生浅静脉曲张和皮肤色素沉着占50．5％，取栓组为31．8％。结论：手术取栓可以保护部分患者下肢的主干深静脉瓣膜，可能减少下肢深静脉血栓形成后遗症。