CAJ | 학술논문

目的探讨大隐静脉高位结扎剥脱术后深静脉血栓形成(deep venous thrombosis,DVT)的临床特点、病因及预防措施.方法回顾性分析收治的12例行大隐静脉高位结扎剥脱术后合并DVT患者的临床特点及诊疗方法,并讨论病因及预防措施.结果 12例DVT患者中7例为中央型,2例为周围型,3例为混合型.DVT合并肺栓塞2例.10例中央型和混合型DVT的肢体增粗症状严重,肢围差距均＞5 cm.9例行下腔静脉滤器(inferior vena cava filter,(IV)CF)保护下的腘静脉置管溶栓术( catheter-directed thrombolysis,CDT)治疗,其中l例介入造影过程中发现左股静脉突然中断,中转手术行股静脉探查修复术、CDT及髂静脉支架植入术;8例发现左髂静脉压迫综合征的影像学表现,其中6例在CDT治疗后行髂静脉支架植入术.1例结合术前彩超及造影所见考虑为右大隐静脉残端血栓蔓延至股静脉,行股静脉切开取栓治疗.2例周围型DVT行抗凝为主的综合性药物治疗.本组12例DVT患者均取得较好的近期疗效.结论手术损伤股静脉、大隐静脉残端过长、左髂静脉压迫综合征是大隐静脉高位结扎剥脱术后DVT的临床常见原因.术前明确下肢慢性静脉功能不全的病变类型、术中仔细操作、术后早期下床活动至关重要.
목적 탐토대은정맥고위결찰박탈술후심정맥혈전형성(deep venous thrombosis,DVT)적림상특점、병인급예방조시.방법 회고성분석수치적12례행대은정맥고위결찰박탈술후합병DVT환자적림상특점급진료방법,병토론병인급예방조시.결과 12례DVT환자중7례위중앙형,2례위주위형,3례위혼합형.DVT합병폐전새2례.10례중앙형화혼합형DVT적지체증조증상엄중,지위차거균＞5 cm.9례행하강정맥려기(inferior vena cava filter,(IV)CF)보호하적객정맥치관용전술( catheter-directed thrombolysis,CDT)치료,기중l례개입조영과정중발현좌고정맥돌연중단,중전수술행고정맥탐사수복술、CDT급가정맥지가식입술;8례발현좌가정맥압박종합정적영상학표현,기중6례재CDT치료후행가정맥지가식입술.1례결합술전채초급조영소견고필위우대은정맥잔단혈전만연지고정맥,행고정맥절개취전치료.2례주위형DVT행항응위주적종합성약물치료.본조12례DVT환자균취득교호적근기료효.결론 수술손상고정맥、대은정맥잔단과장、좌가정맥압박종합정시대은정맥고위결찰박탈술후DVT적림상상견원인.술전명학하지만성정맥공능불전적병변류형、술중자세조작、술후조기하상활동지관중요.
Objective To report deep venous thrombosis (DVT) after greater saphenous vein ligation and stripping and to evaluate diagnosis,treatment and prophylaxis. Methods The clinical characteristics, diagnosis and treatment of 12 inpatients with postoperative DVT were analyzed retrospectively. Results Of these 12 cases there were 7 cases of central type DVT,2 cases of peripheral DVT,and 3 cases of mixed type DVT.Secondary pulmonary embolism was complicated in 2 cases.Clinical symptoms in these 10 cases of proximal DVT were all severe.Catheter-directed thrombolysis(CDT) through the ipsilateral popliteal vein with protective(IV)CF was applied for these 10 cases.Of 10 cases,femoral vein was found ligated in 1 case,which was repaired under open surgery. Residual greater saphenous vein thrombus extending into deep vein was proved and managed by successful thrombolectomy in one case.Cockett syndrome were found as the causes in the other 8 cases,6 cases were treated with balloon dilatation angioplasty and endovascular stenting of the iliac vein.The 2 cases of with distal DVT were treated by anticoagulation therapy.All patients were cured. Conclusions Cockett syndrome,femoral vein injury and too long residual greater saphenous vein are common causes of DVT after greater saphenous vein ligation and tripping.Careful selection of cases,correct diagnosis,standard operative manipulation,early ambulation were all important in the prevention of DVT after great saphenous vein varix procedure.