军训伤致急性下肢深静脉血栓形成的介入治疗

目的探讨多种介入方法相互配合对军训伤所致急性下肢深静脉血栓形成（deep venous thrombosis,DVT）的疗效。方法对军训伤所致25例急性DVT行Fogarty导管取栓术,其中单纯取栓3例,取栓联合球囊导管血管成形6例,血管成形联合血管腔内超声消融11例,血管成形和（或）血管腔内超声消融联合支架置入5例。结果髂股段静脉完全开通24例,除2例造影术无血管狭窄,1例管腔直径〉90%未行扩张外,16例狭窄段血管经球囊扩张后管腔直径≥71%,5例狭窄段扩张后残留管腔狭窄仍〉50%,置入相应大小的支架;左髂总静脉开口未能开通1例。25例随访2-70个月,平均34个月,21例临床症状、体征完全消失;3例训练后患肢周径比健侧增粗0.5-1.0cm,经休息、抬高患肢或穿戴血管弹力袜后好转,可从事正常军事训练;1例髂静脉未开通者训练后仍感肢体肿胀。结论多种外科介入技术相互配合可明显提高军训伤所致DVT疗效。

Interventional Treatment for Acute Deep Venous Thrombosis in the Lower Extremities Caused by Military Training Injuries

Objective To evaluate the effect of a combination of multiple interventional methods in the treatment of acute deep venous thrombi （DVT） in the lower extremities caused by military training injuries. Methods Totally 25 cases with DVT caused by military training injuries were treated by Fogarty emboleetomy. Among the cases, simple embolectomy was performed on 3 patients, embolectomy combined with percutaneous transluminal angioplasty （PTA） was carried out in 6, PTA combined with ultrasound ablation was used in 11, and vessel formation combined with ultrasound ablation and stenting was done in 5. Results After the treatments, the iliofemoral vein was patent in 24 of the cases. Among these patients, as shown by intraoperative angiography, the vein was completed patent in 2 cases, 〉90% of the diameter in 1 （no balloon dilation was performed） , ≥ 71% of the diameter in 16 （after being treated by balloon dilation） , and 〉50% of the diameter in 5 （ after receiving balloon dilation for vascular stenosis）. In one patient, the opening of the left common lilac vein was still obstructed. Follow-up was achieved for 2 to 70 months （mean, 34） in the patients, during which the symptoms and signs disappeared in 2t patients. In 3 cases, the perimeter of the disease limb was thicker than the opposite one by 0.5 to 1.0 cm. The situation was improved by conservative therapies. The patient who had obstructive left common iliac vein after the treatment, still complained of swelling of the limbs. Conclusions Multiple interventional methods can remarkably improve the therapeutic effectiveness for DVT caused by military training injuries.