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浙江大学学报（医学版）
浙江大学学报（医学版）  2018, Vol. 47 Issue (6): 577-582    DOI: 10.3785/j.issn.1008-9292.2018.12.02
专题报道     
一体化微创手术治疗髂静脉压迫综合征伴下肢静脉曲张患者疗效观察
王晓辉(),何杨燕,吴子衡,张鸿坤*()
浙江大学医学院附属第一医院血管外科, 浙江 杭州 310003
Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities
WANG Xiaohui(),HE Yangyan,WU Ziheng,ZHANG Hongkun*()
Department of Vascular Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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摘要：

目的: 探讨髂静脉压迫综合征伴下肢静脉曲张的一体化微创手术治疗方案的临床效果。方法: 回顾性分析2017年1月至2018年1月因髂静脉压迫综合征伴下肢静脉曲张在浙江大学医学院附属第一医院接受左髂静脉支架植入术和下肢静脉射频热消融术患者（11例）的临床资料。通过大隐静脉主干穿刺点入路行左髂静脉支架植入术，而后予以大隐静脉主干的射频热消融术。术后当天开始服用利伐沙班至术后6个月、阿司匹林至术后12个月。患者出院后门诊随访6个月以上，同时分别于2周、2个月、6个月复查下肢静脉、髂静脉多普勒超声或CT血管造影。结果: 11例患者均手术成功，术中无并发症发生。随访6个月时，所有患者下肢酸胀缓解率、色素沉着缓解率、皮肤质量改善率和髂静脉支架通畅率均为100%，无静脉曲张复发、髂股静脉血栓及肺栓塞形成。结论: 髂静脉压迫综合征伴下肢静脉曲张患者行一体化微创手术治疗方案，具有微创、安全、有效、经济等优势，具有较大的推广价值。
关键词： 外科手术, 微创性;  下肢;  静脉曲张/外科学;  综合征;  髂静脉;  导管消融术;  支架;  治疗结果    
Abstract:

Objective: To analyze the efficacy of integrated minimally invasive surgery for iliac vein compression syndrome with varicose veins of lower extremities. Methods: From January 2017 to January 2018, 11 patients with iliac vein compression syndrome accompanied by varicose veins of lower extremities underwent left iliac vein stent implantation and radiofrequency thermal ablation of lower extremity veins in the First Affiliated Hospital of Zhejiang University School of Medicine. The left iliac vein stent was implanted through the puncture point approach of the main great saphenous vein, and then radiofrequency thermal ablation of the main saphenous vein was performed. Rivaroxaban and aspirin were administered from the day of surgery for 6 months and 12 months, respectively. After discharge, patients were followed up for more than 6 months. The lower extremity veins, iliac veins were reexamined by Doppler ultrasound or CT angiography at 2 weeks, 2 months and 6 months after surgery. Results: The operations were successfully performed in 11 patients, and no complication was observed during the operation. The rates of soreness and swelling remission, pigmentation and skin quality improvement, and the iliac vein stent patency were 100%. No varicose vein recurrence, iliofemoral vein thrombosis and pulmonary embolism were found. Conclusion: Integrated minimally invasive surgery is safe, effective and less invasive for iliac vein compression syndrome with varicose veins of lower extremities.
Key words: Surgical procedures, minimally invasive    Lower extremity    Varicose veins/surgery    Syndrome    Iliac vein    Catheter ablation    Stents    Treatment outcome
收稿日期: 2018-08-14 出版日期: 2019-03-15
:  R654.3  
基金资助: 国家自然科学基金(81700420);浙江省自然科学基金(LY16H020004)
通讯作者: 张鸿坤     E-mail: ywwxh217@zju.edu.cn;1198050@zju.edu.cn
作者简介: 王晓辉(1983-), 男, 硕士, 主治医师, 主要从事下肢静脉曲张、外周动脉疾病、主动脉疾病等临床研究; E-mail:ywwxh217@zju.edu.cn; https://orcid.org/0000-0002-4830-5028
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引用本文:

王晓辉,何杨燕,吴子衡,张鸿坤. 一体化微创手术治疗髂静脉压迫综合征伴下肢静脉曲张患者疗效观察[J]. 浙江大学学报（医学版）, 2018, 47(6): 577-582.

WANG Xiaohui,HE Yangyan,WU Ziheng,ZHANG Hongkun. Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities. J Zhejiang Univ (Med Sci), 2018, 47(6): 577-582.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.12.02    或    http://www.zjujournals.com/med/CN/Y2018/V47/I6/577

图 1  左髂总静脉支架植入前后数字减影血管造影图像
(n)
随访时间 n 瘀斑 血肿 疼痛 酸胀缓解 色素沉着和皮肤质量改善 大隐静脉主干闭合 髂静脉通畅 深静脉血栓 肺动脉栓塞
2 d 11 11 2 4 2 0 11 11 0 0
2周 11 7 1 0 7 2 11 11 0 0
2个月 11 0 0 0 11 9 11 11 0 0
6个月 11 0 0 0 11 11 11 11 0 0
表 1  患者术后随访资料一览
1 董国祥 . Cockett综合征(文献综述)[J]. 国际外科学杂志, 1997, 24 (2): 93- 95
DONG Guoxiang . Cockett syndrome (literature review)[J]. International Journal of Surgery, 1997, 24 (2): 93- 95
2 戈小虎, 唐加热克, 朱兵 et al. 髂静脉压迫综合征并下肢深静脉血栓的腔内治疗[J]. 新疆医学, 2017, 47 (1): 1- 4
GE Xiaohu , Tangjiareke , ZHU Bing et al. Curative effect of the endovascular treatment on iliac vein compression syndrome combined with lower extremity deep vein thrombosis[J]. Xinjiang Medical Journal, 2017, 47 (1): 1- 4
doi: 10.3969/j.issn.1009-5551.2017.01.001
3 张杰, 邵初晓 . 髂静脉压迫综合征的研究进展[J]. 中国普通外科杂志, 2015, 24 (6): 880- 884
ZHANG Jie , SHAO Chuxiao . Iliac vein compression syndrome:recent progress[J]. Chinese Journal of General Surgery, 2015, 24 (6): 880- 884
4 WITTENS C , DAVIES A H , B?KGAARD N et al. Editor's choice-management of chronic venous disease:clinical practice guidelines of the European Society for Vascular Surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2015, 49 (6): 678- 737
doi: 10.1016/j.ejvs.2015.02.007
5 李晓强, 钱爱民.髂静脉受压综合征的诊断和治疗[J/OL].中国血管外科杂志(电子版), 2013, 5(1): 6-8.
LI Xiaoqiang, QIAN Aimin. Diagnosis and treatment of iliac vein compression syndrome[J/OL]. Chinese Journal of Vascular Surgery(Electronic Version), 2013, 5(1): 6-8. (in Chinese)
6 LE T B , LEE T K , PARK K M et al. Contralateral deep vein thrombosis after iliac vein stent placement in patients with may-thurner syndrome[J]. J Vasc Interv Radiol, 2018, 29 (6): 774- 780
doi: 10.1016/j.jvir.2018.01.771
7 RAJU S . Best management options for chronic iliac vein stenosis and occlusion[J]. J Vasc Surg, 2013, 57 (4): 1163- 1169
doi: 10.1016/j.jvs.2012.11.084
8 YE K , LU X , LI W et al. Long-term outcomes of stent placement for symptomatic nonthrombotic iliac vein compression lesions in chronic venous disease[J]. J Vasc Interv Radiol, 2012, 23 (4): 497- 502
doi: 10.1016/j.jvir.2011.12.021
9 CALISTE X A , CLARK A L , DOYLE A J et al. The incidence of contralateral iliac venous thrombosis after stenting across the iliocaval confluence in patients with acute or chronic venous outflow obstruction[J]. J Vasc Surg Venous Lymphat Disord, 2014, 2 (3): 253- 259
doi: 10.1016/j.jvsv.2013.12.007
10 HARTUNG O , LOUNDOU A D , BARTHELEMY P et al. Endovascular management of chronic disabling ilio-caval obstructive lesions:long-term results[J]. Eur J Vasc Endovasc Surg, 2009, 38 (1): 118- 124
doi: 10.1016/j.ejvs.2009.03.004
11 黄丽佳, 陆信武.非血栓性髂静脉压迫性病变的诊治进展[J/CD].中国血管外科杂志(电子版), 2015, 7(1): 56-59.
HUANG Lijia, LU Xinwu. Advances in diagnosis and treatment of nonthrombotic iliac venous compression syndrome[J/CD]. Chinese Journal of Vascular Surgery(Electronic Version), 2015, 7(1): 56-59.(in Chinese)
12 MONAHAN D L . Can phlebectomy be deferred in the treatment of varicose veins?[J]. J Vasc Surg, 2005, 42 (6): 1145- 1149
doi: 10.1016/j.jvs.2005.08.034
13 杨心蕊, 殷敏毅, 刘晓兵 et al. 支架成形术改善下肢非血栓性髂静脉受压综合征预后的回顾性队列研究[J]. 中华血管外科杂志, 2016, 1 (1): 26- 29, 36
YANG Xinrui , YIN Minyi , LIU Xiaobing et al. The research in improving prognosis of stent placement for nonthrombotic iliac venous compression syndrome[J]. Chinese Journal of Vascular Surgery, 2016, 1 (1): 26- 29, 36
14 丁锦辉, 丁贺义, 刘军乐 et al. 下肢静脉曲张并髂静脉压迫综合征一体化微创治疗临床观察[J]. 新疆医学, 2018, 48 (2): 174- 177
DING Jinhui , DING Heyi , LIU Junle et al. Minimally invasive treatment integrated of varicose veins in lower extremity complicated with iliac vein compression syndrome[J]. Xinjiang Medical Journal, 2018, 48 (2): 174- 177
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