髂靜脈壓迫綜合征并發(fā)下肢深靜脈血栓形成診治的臨床分析
發(fā)布時間：2018-11-17 09:46
【摘要】：目的:探討髂靜脈壓迫綜合征并發(fā)下肢深靜脈血栓形成的診斷與治療。方法:回顧性分析和探討我院血管外科2011.08-2014.07診療的156例髂靜脈壓迫綜合征(IVCS)并發(fā)下肢深靜脈血栓形成(DVT)患者的臨床資料。156例患者中,年齡構(gòu)成以40歲以上為主,占85.3%,男女比例為0.66:1。全組病例主要以患肢急性腫脹、疼痛不適就診,其中左下肢病變152例,右下肢病變4例。從發(fā)病到就診時間8小時-31天,平均6.35±5.74天,其中2周內(nèi)的共143例,2周至31天的共13例;發(fā)生于髂-股靜脈的血栓共50例,全下肢深靜脈血栓形成共106例。DVT診斷主要經(jīng)血漿D-二聚體、彩色多普勒超聲檢查,溶栓治療后行患肢靜脈順行造影及經(jīng)股靜脈插管髂靜脈造影確診并證實合并有IVCS。本組2例因病史超過1個月行單純抗凝治療,另外154例于下腔靜脈濾器植入保護下行患肢深靜脈置管溶栓治療(CDT),其中64例于CDT治療后行球囊導(dǎo)管擴張成形(PTA)聯(lián)合支架植入術(shù),2例行單純PTA,另外90例未進一步行介入手術(shù)處理髂靜脈病變而僅予抗凝治療,全組患者治療期間均予規(guī)范抗凝。結(jié)果:全組隨訪131例,占84.0%,隨訪時間為3-27個月,平均9.34±5.31個月。IVCS介入治療操作成功率94.3%。行PTA聯(lián)合支架植入治療64例臨床癥狀和體征明顯改善,58例獲得隨訪,隨訪時間為3-27個月,平均9.29±5.91個月,2例因未規(guī)律服藥及長時間制動導(dǎo)致血栓復(fù)發(fā)、支架堵塞,表現(xiàn)為下肢腫脹、疼痛,其余56例癥狀完全緩解。行單純PTA治療2例臨床癥狀和體征明顯改善,2例獲得隨訪,隨訪時間均為12個月。單純抗凝治療90例,71例獲得隨訪,隨訪時間3-24個月,平均9.45±4.77個月,41例癥狀基本緩解,3例患者深靜脈血栓再發(fā),另外27例仍有不同程度下肢腫脹。結(jié)論:IVCS是下肢DVT發(fā)生的重要原因,血漿D-二聚體、彩色多普勒超聲檢查及下肢靜脈順行造影檢查是診斷DVT的主要方法,IVCS診斷需靠造影檢查,其中經(jīng)股靜脈插管髂靜脈造影是診斷IVCS的金標(biāo)準(zhǔn);導(dǎo)管溶栓治療聯(lián)合髂靜脈PTA及支架植入是治療IVCS并發(fā)下肢DVT的有效方法;抗凝是血栓治療的基礎(chǔ),需貫穿治療全程。
[Abstract]:Objective: to investigate the diagnosis and treatment of iliac vein compression syndrome complicated with deep venous thrombosis of lower extremity. Methods: the clinical data of 156 patients with iliac vein compression syndrome (IVCS) complicated with deep venous thrombosis (DVT) of lower extremity in our hospital from 2011.08-2014.07 were retrospectively analyzed and discussed. The age composition is mainly over 40 years old, accounting for 85.3%, the ratio of male and female is 0.66: 1. The patients were mainly treated with acute swelling and discomfort of the affected limbs, including 152 cases of left lower limb disease and 4 cases of right lower extremity disease. The average time from onset to visit was 6.35 鹵5.74 days (8 hours to 31 days), including 143 cases in 2 weeks and 13 cases in 2 weeks to 31 days. There were 50 cases of iliofemoral vein thrombosis and 106 cases of deep vein thrombosis of the whole lower extremity. DVT was mainly diagnosed by plasma D-dimer and color Doppler ultrasound. After thrombolytic therapy, antegrade angiography of the affected limb vein and iliac vein angiography via femoral vein intubation were performed to confirm the presence of IVCS.. Two patients were treated with anticoagulant therapy for more than one month due to their history. Another 154 patients were treated with thrombolytic therapy by inserting thrombolytic catheter into the deep vein of the affected limb under the protection of inferior vena cava filter. After CDT treatment, 64 cases were treated with balloon catheter dilatation (PTA) combined with stent implantation, 2 cases with PTA, alone and 90 cases with only anticoagulant therapy without further interventional operation to treat iliac vein lesions. All patients were treated with standard anticoagulant during treatment. Results: 131cases (84.0%) were followed up for 3-27 months (mean 9.34 鹵5.31 months). The success rate of interventional therapy in IVCS was 94.3%. The clinical symptoms and signs of 64 cases treated with PTA combined with stent implantation were obviously improved. 58 cases were followed up for 3-27 months (mean 9.29 鹵5.91 months). The stents were clogged with swelling and pain in the lower extremities, and the rest 56 cases were completely relieved. The clinical symptoms and signs were significantly improved in 2 cases treated with PTA alone, and 2 cases were followed up for 12 months. 90 cases were treated with anticoagulation alone, 71 cases were followed up. The follow-up time was 3-24 months (mean 9.45 鹵4.77 months), 41 cases were basically relieved, 3 cases had recurrence of deep venous thrombosis, and 27 cases still had lower extremity swelling. Conclusion: IVCS is an important cause of lower extremity DVT. Plasma D-dimer, color Doppler ultrasound and anterograde venography of lower extremity are the main methods for the diagnosis of DVT. The diagnosis of IVCS depends on angiography. Iliac venography via femoral vein intubation is the gold standard for the diagnosis of IVCS. Catheter thrombolytic therapy combined with iliac vein PTA and stent implantation is an effective method for the treatment of IVCS complicated with lower limb DVT.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.4
本文編號：2337344
[Abstract]:Objective: to investigate the diagnosis and treatment of iliac vein compression syndrome complicated with deep venous thrombosis of lower extremity. Methods: the clinical data of 156 patients with iliac vein compression syndrome (IVCS) complicated with deep venous thrombosis (DVT) of lower extremity in our hospital from 2011.08-2014.07 were retrospectively analyzed and discussed. The age composition is mainly over 40 years old, accounting for 85.3%, the ratio of male and female is 0.66: 1. The patients were mainly treated with acute swelling and discomfort of the affected limbs, including 152 cases of left lower limb disease and 4 cases of right lower extremity disease. The average time from onset to visit was 6.35 鹵5.74 days (8 hours to 31 days), including 143 cases in 2 weeks and 13 cases in 2 weeks to 31 days. There were 50 cases of iliofemoral vein thrombosis and 106 cases of deep vein thrombosis of the whole lower extremity. DVT was mainly diagnosed by plasma D-dimer and color Doppler ultrasound. After thrombolytic therapy, antegrade angiography of the affected limb vein and iliac vein angiography via femoral vein intubation were performed to confirm the presence of IVCS.. Two patients were treated with anticoagulant therapy for more than one month due to their history. Another 154 patients were treated with thrombolytic therapy by inserting thrombolytic catheter into the deep vein of the affected limb under the protection of inferior vena cava filter. After CDT treatment, 64 cases were treated with balloon catheter dilatation (PTA) combined with stent implantation, 2 cases with PTA, alone and 90 cases with only anticoagulant therapy without further interventional operation to treat iliac vein lesions. All patients were treated with standard anticoagulant during treatment. Results: 131cases (84.0%) were followed up for 3-27 months (mean 9.34 鹵5.31 months). The success rate of interventional therapy in IVCS was 94.3%. The clinical symptoms and signs of 64 cases treated with PTA combined with stent implantation were obviously improved. 58 cases were followed up for 3-27 months (mean 9.29 鹵5.91 months). The stents were clogged with swelling and pain in the lower extremities, and the rest 56 cases were completely relieved. The clinical symptoms and signs were significantly improved in 2 cases treated with PTA alone, and 2 cases were followed up for 12 months. 90 cases were treated with anticoagulation alone, 71 cases were followed up. The follow-up time was 3-24 months (mean 9.45 鹵4.77 months), 41 cases were basically relieved, 3 cases had recurrence of deep venous thrombosis, and 27 cases still had lower extremity swelling. Conclusion: IVCS is an important cause of lower extremity DVT. Plasma D-dimer, color Doppler ultrasound and anterograde venography of lower extremity are the main methods for the diagnosis of DVT. The diagnosis of IVCS depends on angiography. Iliac venography via femoral vein intubation is the gold standard for the diagnosis of IVCS. Catheter thrombolytic therapy combined with iliac vein PTA and stent implantation is an effective method for the treatment of IVCS complicated with lower limb DVT.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.4
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