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浙江大学学报(医学版)  2022, Vol. 51 Issue (3): 341-349    DOI: 10.3724/zdxbyxb-2022-0121
原著     
一站式腔内介入治疗髂静脉压迫综合征继发下肢深静脉血栓疗效观察
姜广伟,丁殿柱,张晓宇,牛帅,吕柏楠()
河北省人民医院血管外科,河北 石家庄 050051
Efficacy of one-stop endovascular intervention in treatment of left iliac vein compression syndrome complicated with deep venous thrombosis of lower limbs
JIANG Guangwei,DING Dianzhu,ZHANG Xiaoyu,NIU Shuai,LYU Bonan()
Department of Vascular Surgery, Hebei General Hospital, Shijiazhuang 050051, China
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摘要:

目的:探讨一站式腔内介入治疗髂静脉压迫综合征(IVCS)继发下肢深静脉血栓(DVT)临床效果及安全性。方法:回顾性分析2018年1月至2021年12月于河北省人民医院血管外科因左侧IVCS继发DVT入院治疗的26例患者的资料,均采用超声引导下膝下深静脉穿刺、Angiojet导管吸栓、髂静脉球囊扩张及支架植入、同期滤器取出的一站式腔内介入治疗,记录手术时间和导管吸栓时间;观察手术前后左下肢深静脉通畅度评分、健患肢膝上15?cm和膝下10?cm周径差,以及手术前后1?d血红蛋白量、肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、间接胆红素水平变化。通过随访,评价血栓后综合征发生率及髂静脉支架通畅情况。结果:26例患者均成功实施一站式腔内介入治疗,手术时间为(171±35)min,吸栓时间为(263±89)s。与手术治疗前相比,手术治疗后静脉通畅度评分、健患肢膝上及膝下周径差均减小(均P<0.01);血红蛋白量减少,肌酐、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素及间接胆红素水平均上升(均P<0.01)。患者随访时间为1~12个月,其中1例患者7个月后出现支架内血栓形成,经保守治疗后症状改善;1例患者存在支架内附壁血栓形成,支架内血流无影响;其余患者均支架通畅。所有患者随访期间未见血栓后综合征。结论:一站式腔内介入治疗IVCS合并左下肢DVT安全可行,治疗过程中须关注导管吸栓所致的肝肾功能指标的变化,及时给予相应干预,避免相关并发症发生。

关键词: 髂静脉压迫综合征深静脉血栓形成导管吸栓支架植入疗效安全性    
Abstract:

Objective: To evaluate the clinical effect and safety of one-stop endovascular intervention in treatment of left iliac vein compression syndrome (IVCS) complicated with deep venous thrombosis (DVT) of lower limbs. Methods: Clinical data of 26 patients with secondary DVT due to IVCS admitted in the Department of Vascular Surgery, Hebei General Hospital from January 2018 to December 2021 were retrospectively analyzed. All patients underwent one-stop endovascular intervention procedure, including ultrasound-guided deep venipuncture, Angiojet catheter aspiration, iliac vein balloon dilation, stent implantation and simultaneous filter retrieval. The operation time and catheter aspiration time were documented; the preoperative and postoperative left lower extremity deep vein venous patency, circumferences of bilateral limbs at 15?cm above the knee and 10?cm below the knee, and the levels of hemoglobin, creatinine, alanine aminotransferase (ALT), aspertate aminotransferase (AST), total bilirubin and indirect bilirubin were measured. The incidence of post-thrombotic syndrome (PTS) and iliac vein stent patency were recorded through follow-up. Results: The one-stop endovascular intervention was successfully performed in 26 patients, with the operation time of (171±35)?min and the thrombolysis time of (263±89)?s. After treatment, the left lower extremity deep vein venous patency, circumferences of bilateral limbs at 15?cm above the knee and 10?cm below the knee were decreased (all P<0.01); the hemoglobin level were decreased, the creatinine, ALT, AST, total bilirubin and indirect bilirubin levels were increased (allP<0.01). Patients were followed up for 1–12?months. Stent thrombosis occurred in 1 patient 7?months after procedure, and the symptoms were improved after conservative treatment; the stents were unobstructed in all patients, 1 patient had stent mural thrombosis, in whom the stent blood flow was not affected. No PTS was observed during the follow-up.Conclusions: The one-stop endovascular interventional treatment of IVCS complicated with DVT of left lower limb is safe and effective. Attention should be paid to the changes of liver and kidney function caused by catheter aspiration during the treatment, and corresponding intervention should be given in time to avoid the occurrence of related complications.

Key words: Iliac vein compression syndrome    Deep venous thrombosis    Catheter aspiration thrombus    Stent implantation    Efficacy    Safety
收稿日期: 2022-03-24 出版日期: 2022-09-21
CLC:  R654.4  
基金资助: 河北省医学科学研究计划(20190383)
通讯作者: 吕柏楠     E-mail: lvbonan123@126.com
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引用本文:

姜广伟,丁殿柱,张晓宇,牛帅,吕柏楠. 一站式腔内介入治疗髂静脉压迫综合征继发下肢深静脉血栓疗效观察[J]. 浙江大学学报(医学版), 2022, 51(3): 341-349.

JIANG Guangwei,DING Dianzhu,ZHANG Xiaoyu,NIU Shuai,LYU Bonan. Efficacy of one-stop endovascular intervention in treatment of left iliac vein compression syndrome complicated with deep venous thrombosis of lower limbs. J Zhejiang Univ (Med Sci), 2022, 51(3): 341-349.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2022-0121        https://www.zjujournals.com/med/CN/Y2022/V51/I3/341

图 1  1例左侧髂静脉压迫综合征继发下肢深静脉血栓患者一站式腔内介入治疗术中影像女性患者,60岁,因突发左下肢肿胀疼痛1 d入院. A:股浅静脉、腘静脉血栓形成(箭头所示);B:髂股静脉全程血栓形成;C:Angiojet导管吸栓后髂外静脉及股静脉血流通畅;D:左侧髂总静脉开口重度狭窄(箭头所示);E、F:球囊扩张髂总静脉狭窄处(箭头所示髂总静脉重度狭窄);G:左侧髂静脉支架植入,造影血流通畅;H:回收下腔静脉滤器.

检测时间

n

静脉通畅度评分

膝上周径差(cm)

膝下周径差(cm)

治疗前

26

9.5(6,12)

6.3(5.5,7.0)

5.33±0.89

治疗后

26

0(0,0)

2.0(1.6,2.8)

1.70±0.48

t/Z

–4.481

17.427

19.268

P

<0.01

<0.01

<0.01

表 1  患者治疗前后静脉通畅度评分、健患肢周径差变化

检测时间

n

血红蛋白(g/L)

肌酐(μmol/L)

丙氨酸转氨酶(U/L)

天冬氨酸转氨酶(U/L)

总胆红素(μmol/L)

间接胆红素(μmol/L)

治疗前

26

125±14

57.4 (53.3,69.1)

11.17 (10.43,32.33)

22.60 (16.84,43.88)

18.45 (16.96,19.73)

14.3±2.5

治疗后

26

113±16

64.2 (56.9,82.9)

24.10 (15.26,55.35)

57.65 (31.40,91.70)

30.85 (21.15,43.28)

26.5±10.6

t/Z

7.921

–3.004

–3.264

–4.229

–5.769

–6.123

P

<0.01

<0.01

<0.01

<0.01

<0.01

<0.01

表 2  患者治疗前后血红蛋白量和肝肾功能指标变化
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