CAJ | 학술논문

目的探讨下肢深静脉血栓形成(DVT)合并下腔静脉(IVC)血栓的临床特点及诊疗经验.方法回顾性分析山东大学附属省立医院血管外科2008年5月至2012年5月期间收治的20例下肢DVT合并IVC血栓患者的临床特点及诊疗措施.结果 20例DVT均为中央型或混合型,肢体粗肿症状严重,肢围差距均＞4 cm,3例出现股青肿,3例合并症状性肺动脉栓塞,肾下水平IVC完全闭塞5例(其中3例为外院行下腔静脉滤器植入术后合并IVC血栓),非完全闭塞性IVC血栓15例.17例(17/20)行可回收的下腔静脉滤器(IVCF)植入术,并均在21 d内成功回收IVCF.15例非闭塞性lVC血栓中的8例(8/15)给予尿激酶全身溶栓治疗,7例(7/15)行同侧腘静脉置管溶栓术(CDT)治疗,其中5例(5/7)合并左髂静脉压迫综合征,3例(3/5)在CDT治疗后行左髂静脉支架植入术.15例非闭塞性IVC血栓者,经治疗2周后造影证实IVC血栓完全消失,临床症状、体征明显缓解.5例(5/20)IVC完全闭塞者中的3例行双侧股、腘静脉CDT治疗,治疗后IVC血栓部分溶解,其余2例行药物治疗.结论 IVCF保护下全身或局部溶栓均能安全有效的治疗DVT合并的非完全闭塞性IVC血栓,而临床症状明显的完全闭塞性IVC血栓应更多的考虑使用局部CDT治疗.
목적 탐토하지심정맥혈전형성(DVT)합병하강정맥(IVC)혈전적림상특점급진료경험.방법 회고성분석산동대학부속성립의원혈관외과2008년5월지2012년5월기간수치적20례하지DVT합병IVC혈전환자적림상특점급진료조시.결과 20례DVT균위중앙형혹혼합형,지체조종증상엄중,지위차거균＞4 cm,3례출현고청종,3례합병증상성폐동맥전새,신하수평IVC완전폐새5례(기중3례위외원행하강정맥려기식입술후합병IVC혈전),비완전폐새성IVC혈전15례.17례(17/20)행가회수적하강정맥려기(IVCF)식입술,병균재21 d내성공회수IVCF.15례비폐새성lVC혈전중적8례(8/15)급여뇨격매전신용전치료,7례(7/15)행동측객정맥치관용전술(CDT)치료,기중5례(5/7)합병좌가정맥압박종합정,3례(3/5)재CDT치료후행좌가정맥지가식입술.15례비폐새성IVC혈전자,경치료2주후조영증실IVC혈전완전소실,림상증상、체정명현완해.5례(5/20)IVC완전폐새자중적3례행쌍측고、객정맥CDT치료,치료후IVC혈전부분용해,기여2례행약물치료.결론 IVCF보호하전신혹국부용전균능안전유효적치료DVT합병적비완전폐새성IVC혈전,이림상증상명현적완전폐새성IVC혈전응경다적고필사용국부CDT치료.
Objective To explore the clinical profiles of patients with lower extremity deep venous thrombosis (DVT) complicated with inferior vena cava (IVC) thrombus and summarize their clinical diagnostic and therapeutic experiences.Methods The clinical characteristics,diagnosis and treatment of 20 hospitalized patients with DVT complicated with inferior vena cava thrombus were analyzed retrospectively.Results All of them were of proximal DVT.There were phlegmasia cerulea dolens (n =3),pulmonary embolism (n =3) and completely occlusion of IVC (n =5).Clinical manifestations were severe.Retrievable inferior vena cava filter (IVCF) was implanted for 17 cases.Catheter-directed thrombolysis (CDT) through ipsilateral popliteal vein was applied for 7 cases and systemic thrombolysis therapy for 8 cases.The effective rate of thrombolysis for fresh IVC thrombus was 100％.Among 5 cases with Cockett Syndrome,3 cases underwent balloon dilatation angioplasty and endovascular stenting of iliac vein.And 17 IVCFs were retrieved successfully within 3 weeks.IVC thrombus disappeared completely in 15 cases.Conclusion Systemic or local thrombolysis with protective IVCF is a safe and effective therapy for nonocclusive IVC thrombus in DVT.And CDT is recommended for symptomatic occlusive IVC thrombus.