髂静脉压迫综合征并发下肢深静脉血栓形成诊治的临床分析
发布时间：2018-11-17 09:46
【摘要】：目的:探讨髂静脉压迫综合征并发下肢深静脉血栓形成的诊断与治疗。方法:回顾性分析和探讨我院血管外科2011.08-2014.07诊疗的156例髂静脉压迫综合征(IVCS)并发下肢深静脉血栓形成(DVT)患者的临床资料。156例患者中,年龄构成以40岁以上为主,占85.3%,男女比例为0.66:1。全组病例主要以患肢急性肿胀、疼痛不适就诊,其中左下肢病变152例,右下肢病变4例。从发病到就诊时间8小时-31天,平均6.35±5.74天,其中2周内的共143例,2周至31天的共13例;发生于髂-股静脉的血栓共50例,全下肢深静脉血栓形成共106例。DVT诊断主要经血浆D-二聚体、彩色多普勒超声检查,溶栓治疗后行患肢静脉顺行造影及经股静脉插管髂静脉造影确诊并证实合并有IVCS。本组2例因病史超过1个月行单纯抗凝治疗,另外154例于下腔静脉滤器植入保护下行患肢深静脉置管溶栓治疗(CDT),其中64例于CDT治疗后行球囊导管扩张成形(PTA)联合支架植入术,2例行单纯PTA,另外90例未进一步行介入手术处理髂静脉病变而仅予抗凝治疗,全组患者治疗期间均予规范抗凝。结果:全组随访131例,占84.0%,随访时间为3-27个月,平均9.34±5.31个月。IVCS介入治疗操作成功率94.3%。行PTA联合支架植入治疗64例临床症状和体征明显改善,58例获得随访,随访时间为3-27个月,平均9.29±5.91个月,2例因未规律服药及长时间制动导致血栓复发、支架堵塞,表现为下肢肿胀、疼痛,其余56例症状完全缓解。行单纯PTA治疗2例临床症状和体征明显改善,2例获得随访,随访时间均为12个月。单纯抗凝治疗90例,71例获得随访,随访时间3-24个月,平均9.45±4.77个月,41例症状基本缓解,3例患者深静脉血栓再发,另外27例仍有不同程度下肢肿胀。结论:IVCS是下肢DVT发生的重要原因,血浆D-二聚体、彩色多普勒超声检查及下肢静脉顺行造影检查是诊断DVT的主要方法,IVCS诊断需靠造影检查,其中经股静脉插管髂静脉造影是诊断IVCS的金标准;导管溶栓治疗联合髂静脉PTA及支架植入是治疗IVCS并发下肢DVT的有效方法;抗凝是血栓治疗的基础,需贯穿治疗全程。
[Abstract]:Objective: to investigate the diagnosis and treatment of iliac vein compression syndrome complicated with deep venous thrombosis of lower extremity. Methods: the clinical data of 156 patients with iliac vein compression syndrome (IVCS) complicated with deep venous thrombosis (DVT) of lower extremity in our hospital from 2011.08-2014.07 were retrospectively analyzed and discussed. The age composition is mainly over 40 years old, accounting for 85.3%, the ratio of male and female is 0.66: 1. The patients were mainly treated with acute swelling and discomfort of the affected limbs, including 152 cases of left lower limb disease and 4 cases of right lower extremity disease. The average time from onset to visit was 6.35 卤5.74 days (8 hours to 31 days), including 143 cases in 2 weeks and 13 cases in 2 weeks to 31 days. There were 50 cases of iliofemoral vein thrombosis and 106 cases of deep vein thrombosis of the whole lower extremity. DVT was mainly diagnosed by plasma D-dimer and color Doppler ultrasound. After thrombolytic therapy, antegrade angiography of the affected limb vein and iliac vein angiography via femoral vein intubation were performed to confirm the presence of IVCS.. Two patients were treated with anticoagulant therapy for more than one month due to their history. Another 154 patients were treated with thrombolytic therapy by inserting thrombolytic catheter into the deep vein of the affected limb under the protection of inferior vena cava filter. After CDT treatment, 64 cases were treated with balloon catheter dilatation (PTA) combined with stent implantation, 2 cases with PTA, alone and 90 cases with only anticoagulant therapy without further interventional operation to treat iliac vein lesions. All patients were treated with standard anticoagulant during treatment. Results: 131cases (84.0%) were followed up for 3-27 months (mean 9.34 卤5.31 months). The success rate of interventional therapy in IVCS was 94.3%. The clinical symptoms and signs of 64 cases treated with PTA combined with stent implantation were obviously improved. 58 cases were followed up for 3-27 months (mean 9.29 卤5.91 months). The stents were clogged with swelling and pain in the lower extremities, and the rest 56 cases were completely relieved. The clinical symptoms and signs were significantly improved in 2 cases treated with PTA alone, and 2 cases were followed up for 12 months. 90 cases were treated with anticoagulation alone, 71 cases were followed up. The follow-up time was 3-24 months (mean 9.45 卤4.77 months), 41 cases were basically relieved, 3 cases had recurrence of deep venous thrombosis, and 27 cases still had lower extremity swelling. Conclusion: IVCS is an important cause of lower extremity DVT. Plasma D-dimer, color Doppler ultrasound and anterograde venography of lower extremity are the main methods for the diagnosis of DVT. The diagnosis of IVCS depends on angiography. Iliac venography via femoral vein intubation is the gold standard for the diagnosis of IVCS. Catheter thrombolytic therapy combined with iliac vein PTA and stent implantation is an effective method for the treatment of IVCS complicated with lower limb DVT.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.4
本文编号：2337344
[Abstract]:Objective: to investigate the diagnosis and treatment of iliac vein compression syndrome complicated with deep venous thrombosis of lower extremity. Methods: the clinical data of 156 patients with iliac vein compression syndrome (IVCS) complicated with deep venous thrombosis (DVT) of lower extremity in our hospital from 2011.08-2014.07 were retrospectively analyzed and discussed. The age composition is mainly over 40 years old, accounting for 85.3%, the ratio of male and female is 0.66: 1. The patients were mainly treated with acute swelling and discomfort of the affected limbs, including 152 cases of left lower limb disease and 4 cases of right lower extremity disease. The average time from onset to visit was 6.35 卤5.74 days (8 hours to 31 days), including 143 cases in 2 weeks and 13 cases in 2 weeks to 31 days. There were 50 cases of iliofemoral vein thrombosis and 106 cases of deep vein thrombosis of the whole lower extremity. DVT was mainly diagnosed by plasma D-dimer and color Doppler ultrasound. After thrombolytic therapy, antegrade angiography of the affected limb vein and iliac vein angiography via femoral vein intubation were performed to confirm the presence of IVCS.. Two patients were treated with anticoagulant therapy for more than one month due to their history. Another 154 patients were treated with thrombolytic therapy by inserting thrombolytic catheter into the deep vein of the affected limb under the protection of inferior vena cava filter. After CDT treatment, 64 cases were treated with balloon catheter dilatation (PTA) combined with stent implantation, 2 cases with PTA, alone and 90 cases with only anticoagulant therapy without further interventional operation to treat iliac vein lesions. All patients were treated with standard anticoagulant during treatment. Results: 131cases (84.0%) were followed up for 3-27 months (mean 9.34 卤5.31 months). The success rate of interventional therapy in IVCS was 94.3%. The clinical symptoms and signs of 64 cases treated with PTA combined with stent implantation were obviously improved. 58 cases were followed up for 3-27 months (mean 9.29 卤5.91 months). The stents were clogged with swelling and pain in the lower extremities, and the rest 56 cases were completely relieved. The clinical symptoms and signs were significantly improved in 2 cases treated with PTA alone, and 2 cases were followed up for 12 months. 90 cases were treated with anticoagulation alone, 71 cases were followed up. The follow-up time was 3-24 months (mean 9.45 卤4.77 months), 41 cases were basically relieved, 3 cases had recurrence of deep venous thrombosis, and 27 cases still had lower extremity swelling. Conclusion: IVCS is an important cause of lower extremity DVT. Plasma D-dimer, color Doppler ultrasound and anterograde venography of lower extremity are the main methods for the diagnosis of DVT. The diagnosis of IVCS depends on angiography. Iliac venography via femoral vein intubation is the gold standard for the diagnosis of IVCS. Catheter thrombolytic therapy combined with iliac vein PTA and stent implantation is an effective method for the treatment of IVCS complicated with lower limb DVT.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.4
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