CAJ | 학술논문

目的探讨髂腹股沟入路相关急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的病因、临床特点及诊疗经验.方法回顾性分析河南省洛阳正骨医院2008年1月至2013年12月诊治的11例髂腹股沟手术入路相关急性医源性下肢DVT患者的临床特点及治疗措施.结果 11例复杂髋臼骨折病例,行髂腹股沟(ilioninguinal)入路手术7例,联合Kocher-Langenbeck入路4例,术后3d内并发患肢DVT,均经数字减影血管造影(digital subtraction angiography,DSA)证实了DVT与髂腹股沟入路手术关系密切,11例均在髂腹股沟段出现静脉狭窄,狭窄段远侧血栓形成9例,上下侧均有血栓形成2例,1例合并髂静脉广泛闭塞,1例合并股静脉广泛闭塞,均放置可回收型下腔静脉滤器,同期行经导管推注尿激酶接触溶栓治疗,溶栓治疗5～12d,平均(8.0±2.3)d,血栓完全溶解8例,少量残留3例,闭塞髂股静脉完全开通,随访6～18个月,平均(10±4)个月,无DVT复发及PTS发生.结论髂腹股沟入路手术可对术区髂股静脉造成严重影响,是导致急性下肢深静脉血栓形成的重要原因,下腔静脉滤器保护下接触溶栓疗效确切.
목적 탐토가복고구입로상관급성하지심정맥혈전형성(deep venous thrombosis,DVT)적병인、림상특점급진료경험.방법 회고성분석하남성락양정골의원2008년1월지2013년12월진치적11례가복고구수술입로상관급성의원성하지DVT환자적림상특점급치료조시.결과 11례복잡관구골절병례,행가복고구(ilioninguinal)입로수술7례,연합Kocher-Langenbeck입로4례,술후3d내병발환지DVT,균경수자감영혈관조영(digital subtraction angiography,DSA)증실료DVT여가복고구입로수술관계밀절,11례균재가복고구단출현정맥협착,협착단원측혈전형성9례,상하측균유혈전형성2례,1례합병가정맥엄범폐새,1례합병고정맥엄범폐새,균방치가회수형하강정맥려기,동기행경도관추주뇨격매접촉용전치료,용전치료5～12d,평균(8.0±2.3)d,혈전완전용해8례,소량잔류3례,폐새가고정맥완전개통,수방6～18개월,평균(10±4)개월,무DVT복발급PTS발생.결론 가복고구입로수술가대술구가고정맥조성엄중영향,시도치급성하지심정맥혈전형성적중요원인,하강정맥려기보호하접촉용전료효학절.
Objective To evaluate the treatment of ilioinguinal approach surgery associated acute iatrogenic deep venous thrombosis (DVT).Methods The clinical data and treatment of 11 patients with ilioinguinal approach surgery associated acute iatrogenic DVT were analyzed.Results These 11 patients initially suffered from complicated acetabulum fracture,7 cases were treated by single ilioinguinal approach surgery and the other 4 cases were combined with Kocher-Langenbeck approach.In 3 days after surgery,DVTs were found by Doppler sonography,and all the DVTs were proved having closed relationships with ilioinguinal approach through digital subtraction angiography(DSA):iliac-femoral veins appeared stenosis at ilioinguinal segment in all the 11 cases,DVTs were found distal to the stenosis in 9 cases,both sides in 2 cases (1 case combined extensive iliac vein emphraxis and the other case combined extensive femoral vein emphraxis).After retrievable inferior vena cava filters were implanted,11 patients received catheter-directed thrombolysis for 5-12 days.Complete thrombolysis was achieved in 8 cases and thrombi residual left in 3 cases.The iliac-femoral veins were recanalized completely.After (10 ± 4) month fellow-up,no DVT recurred and no PTS appeared.Conclusions Ilioinguinal approach surgery seriously effects iliac-femoral veins,and is a important precipitating factor of DVT.Early catheter-directed thrombolysis under the protection of inferior vena cava filter is an effective treatment.