CAJ | 학술논문

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.
목적 총결수술취전연합강내개입치료급성가고심정맥혈전(DVT)적림상경험.방법 2008년10월지2010년12월,15례급성DVT환자접수수술취전연합동측가정맥강내지가식입술.남성6례,녀성9례;년령36～71세,평균57.4세.DVT위우좌고、가급하강정맥내2례,쌍측가정맥1례,기여12례균재좌가고정맥.소유환자표현환지명현종창,기중12례반유환지동통.DVT발병시간평균위3.3 d.유발DVT적원인포괄외과수술6례,DVT복발2례,기여7례병인불청.병발증포괄소화도출혈1례,위궤양1례,고혈압3례,뇌경사1례.취전지전균선경우고정맥천자식입하강정맥려기(포괄1례쌍가정맥혈전환자),취전지후술중조영균발현가정맥수압치중도협착혹완전폐새,균선행구낭혈관성형후식입자팽식지가.결과 술중조영증실가정맥압박종합정12례,취전후잔류협착3례.공식입18매자팽식지가,수술성공솔15/15,30 d병사솔위0;1례술후상구출현혈종,보수치료후전유.12례획득수방,수방시간위2～26개월,평균13.3개월.소유환자동통소실,부2례표현위활동후환지경도종창.소유환자균미출현혈전복발.결론 수술취전연합강내개입치료급성DVT안전유효,조기림상결과만의,병발증발생솔저.
Objective To evaluate the clinical outcome of surgical venous thrombectomy and simultaneous stenting in patients with acute, symptomatic iliofemoral deep venous thrombosis ( DVT) .Methods From October 2008 to December 2010, a total of 15 patients with acute symptomatic DVT underwent combined surgical venous thrombectomy and endovascular stenting in ipsilateral iliac vein. There were 6 male and 9 female patients, with a mean age of 57. 4 years ( ranging from 36 to 71 years) . All patients underwent Duplex ultrasonography for diagnosis of DVT. The location of thrombosis was femoroiliocaval vein in 2 cases, bilateral iliac vein in 1 case and left iliofemoral vein in 12 cases. All patients had leg swelling and 12 cases had severe leg pain. The mean time of symptomatic DVT occurring at operation was 3. 3 d. The factors related to DVT were operation in 6 cases, DVT reoccur in 2 cases. Coexist diseases were digestive tract bleeding in 1 case, gastric ulcer in 1 case, hypertension in 3 cases and 1 case had cerebral infarction. The inferior vena cava filter was inserted before thrombectomy, iliac vein compression and residual stensosis were treated with a self-expandable stent after thrombectomy. Results Intraoperative venography showed severe venous stenosis in all patients including 80% of iliac vein compression syndrome, 18 self-expandable stents were inserted successfully, the procedural successful rate was 100% , the 30-day mortality rate was 0. One case was suffered from hematoma at incision after operation.3 patients were lost during follow-up. Median follow-up was 10. 3 months ( ranging from 2 to 26 months). There was no case of re-thrombosis. Leg pain was disappeared in all cases and only 2 patients showed slight leg swelling after excise. Conclusion Combined surgical thrombectomy and endovascular treatment for patients with acute symptomatic iliofemoral venous thrombosis is an effective and safe technique with low morbidity and good clinical results.