CAJ | 학술논문

目的：评估支架治疗髂静脉受压综合征（IVCS）的临床疗效。方法回顾性分析2008年1月至2013年3月本院67例行支架治疗的IVCS患者的临床资料，合并急性下肢深静脉血栓形成（DVT）52例，施行导管溶栓后存在髂静脉受压的患者植入支架；合并慢性下肢静脉高压15例，直接植入支架。手术前后测支架两端压差，以及患肢大小腿与健肢周径差。术后1、6个月及1、2、3、5年采用多普勒超声检查随访。结果67例患者共植入支架79枚，直径10～14mm，长度40～100（平均89.7）mm；52例急性病例采用导管溶栓，使用尿激酶量125万～590万(平均297万)U，使用时间2～6(平均2.9)天。支架两端压力差治疗前后比较，差异有统计学意义[（6.23±3.46）cmH2Ovs（1.53±1.73）cmH2O，P＜0.001]。手术前后大、小腿患肢与健肢周径差比较，差异均有统计学意义[(6.13±2.63)cmvs(1.25±1.49)cm；（4.16±2.11）cmvs（1.43±1.13）cm，P＜0.001]。术后1、6个月及1、2、3、5年通畅率分别为97.0%、92.5%、86.6%、85.1%、83.6%及82.1%。5例（7.5%）患者术后穿刺点渗血，加压包扎后痊愈。无全身大出血、支架断裂及移位等并发症。随访2～61（平均45.0）个月，4例患者下肢轻度肿胀，4例有沉重感，PTS发生率为11.9%(8/67)。结论导管溶栓治疗IVCS合并急性DVT安全有效，支架治疗IVCS疗效满意。
목적：평고지가치료가정맥수압종합정（IVCS）적림상료효。방법회고성분석2008년1월지2013년3월본원67례행지가치료적IVCS환자적림상자료，합병급성하지심정맥혈전형성（DVT）52례，시행도관용전후존재가정맥수압적환자식입지가；합병만성하지정맥고압15례，직접식입지가。수술전후측지가량단압차，이급환지대소퇴여건지주경차。술후1、6개월급1、2、3、5년채용다보륵초성검사수방。결과67례환자공식입지가79매，직경10～14mm，장도40～100（평균89.7）mm；52례급성병례채용도관용전，사용뇨격매량125만～590만(평균297만)U，사용시간2～6(평균2.9)천。지가량단압력차치료전후비교，차이유통계학의의[（6.23±3.46）cmH2Ovs（1.53±1.73）cmH2O，P＜0.001]。수술전후대、소퇴환지여건지주경차비교，차이균유통계학의의[(6.13±2.63)cmvs(1.25±1.49)cm；（4.16±2.11）cmvs（1.43±1.13）cm，P＜0.001]。술후1、6개월급1、2、3、5년통창솔분별위97.0%、92.5%、86.6%、85.1%、83.6%급82.1%。5례（7.5%）환자술후천자점삼혈，가압포찰후전유。무전신대출혈、지가단렬급이위등병발증。수방2～61（평균45.0）개월，4례환자하지경도종창，4례유침중감，PTS발생솔위11.9%(8/67)。결론도관용전치료IVCS합병급성DVT안전유효，지가치료IVCS료효만의。
Objective To evaluate the clinical effect of stent trentment for iliac vein compression syndrome (IVCS). Methods The data of the 67 patients with IVCS from Jan. 2008 to Mar. 2013 in our center were analyzed retrospectively. Among 67 cases, 52 cases complicated with acute deep venous thrombosis(DVT) underwent catheter-directed thrombolysis(CDT) and then stenting, and another 15 cases complicated with lower venous hypertension underwent stenting directly. Pressure difference of two ends of stent and perimeter difference between the suffered limb and healthy one were measured before and after operation. The patients were followed up with Duplex ultrasound in 1-, 6-month, 1-, 2-, 3-and 5-year postoperatively, respectively. Results A total of 79 stents were implanted in 67 patients of IVCS. The diameter and length of stent was 10~14mm and 40~100mm(average 89.7mm),respectively. CDT of urokinase was performed on 52 cases of IVCS complicated with acute DVT with a dose of 1.25~5.90(average 2.97)million U for 2~6 (average 2.9) days. The differences of pressure difference of two ends of stent before and after operation were statistical significant [(6.23±3.46) cmH2Ovs (1.53±1.73)cmH2O,P<0.001]. Perimeter differences of thigh and calf between the suffered limb and healthy one were compared, and the differences were significant before and after operation[thigh (6.13±2.63) cm vs (1.25±1.49)cm;calf (4.16±2.11)cm vs (1.43±1.13)cm,P<0.001]. The primary patency rate of 1-, 6-month, 1-, 2-, 3-and 5-year after operation was 97.0%, 92.5%, 86.6%, 85.1%, 83.6%and 82.1%, respectively.Five patients (7.5%) experienced minor bleeding at puncture site and were treated successfully with compression. No large hematoma, stent breakage or migration occurred during the procedure. All patients were followed up for 2~61 (mean,45.0) months. Four patients were found limb swelling and 4 patients felt heaviness.The incidence of post-thrombotic syndrome was 11.9%(8/67). Conclusion The treatment of CDT for patients of IVCS complicated with acute DVT is safe and effective. The treatment of stenting placement for IVCS is satisfied.