南方医科大学学报

南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (01): 131-.

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复合手术治疗左髂静脉受压综合征继发左下肢急性深静脉血栓

周忠信，符方勇，林智琪，潘春球   

  • 出版日期:2013-01-20 发布日期:2013-01-20

Hybrid operation for acute left leg deep venous thrombosis secondary to left iliac vein compression syndrome: analysis of 36 cases

  • Online:2013-01-20 Published:2013-01-20

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摘要： ：目的探讨复合手术治疗左髂静脉受压综合征(IVCS)继发左下肢急性深静脉血栓(LDVT)的操作要点和疗效。方法36例
IVCS继发急性LDVT，予以下腔静脉滤器植入后，2例术中明确为IVCS合并陈旧性LDVT急性发作，放弃左髂静脉支架置入
术。34例经左股静脉切开，以Fogarty上行取栓，远心端序贯挤压取栓。2例予以覆膜支架，32例予以裸支架植入髂总静脉。术
后常规抗凝溶栓，动态监测患肢周径、D-二聚体、血清纤维蛋白原（FBG）和血管通畅情况。结果2例髂静脉支架展开不良行球
囊扩张后残留血栓经裸支架挤入管腔中，予以接触溶栓5~7 d；1例裸支架向后移位予以再次支架纠正；3例因溶栓致FBG下降
出现自限性出血。34例取栓患者治疗第3、6、30和180天患肢周径与治疗前存在统计学差异(踝上5 cm：F=3.060，P=0.030；膝下
10 cm：F=3.114，P=0.028；膝上10 cm：F=2.961，P=0.034)，治疗第3、6、30 和180 天的D-二聚体水平与治疗前有显著差异（F=
3.869，P=0.011），治疗第3、6、30和180天的FBG水平与治疗前比较无统计学差异（F=1.163，P=0.345），总显效率83.3%（26/34），
总有效率91.2 %（31/34）。结论针对IVCS合并急性LDVT，尽可能地取净血栓恢复血流通道后，以支架径向支撑狭窄或闭塞的
髂总静脉，具有可行性。

Abstract: Objective To evaluate the surgical techniques for acute left deep venous thrombosis (LDVT) secondary to left iliac
vein compression syndrome (IVCS). Methods Thirty-six patients with acute LDVT secondary to IVCS received inferior vena
cava filter placement, and in 2 of the cases, stent implantation was canceled for acute episode of obsolete DVT. The remaining
34 patients underwent left femoral venotomy for iliofemoral thrombectomy with Fogarty catheter and distal femoral vein
thrombus removal by sequential compression of the legs, followed by implantation of stent-graft (2 cases) or bare-metal stents
(32 cases) in the left common iliac veins. With routine anticoagulation and thrombolytic treatments, the patients were regularly
examined for postoperative blood flow in the affected limb. Results In 2 of the cases undergoing bare-metal stent implantation,
the residue thrombi were squeezed into the stent by balloon, which was managed subsequently with local thrombolysis. One
patient with bare-metal stent implantation received a secondary stenting for posterior stent displacement. Three patients had
self-limited bleeding due to decreased serum FBG. Significant improvements were achieved at 3, 6, 30 and 180 days
postoperatively in the circumferences of the affected limb (P<0.05) and in the levels of D-dimer (P=0.011), and FBG level
showed no significant variations (F=1.163, P=0.345). The total rate of excellent outcomes was 83.3% (26/34) with a total effective
rate of 91.2% (31/34) in these cases. Conclusions Thrombectomy to revascularize the inflow tract and stent implantation to
enlarge stenosed iliac veins are key issues in treatment of acute LDVT secondary to IVCS.