介入联合手术治疗急性下肢深静脉血栓形成

Interventional and surgical therapy for acute deep vein thrombosis of the lower extremity

目的探讨急性下肢深静脉血栓形成介入联合手术治疗方法。方法2002年1月至2004年12月对42例急性下肢深静脉血栓形成患者,首先经健侧股静脉置入下腔静脉滤器,再切开患侧股静脉,远端血栓以挤压法驱出,近端髂静脉内血栓以Fogany导管取出,球囊扩张左髂静脉狭窄,最后做临时性股动静脉瘘,术后3个月结扎。结果40例治疗成功,37例髂静脉狭窄,7例放置支架;随访34例,3-32个月。26例患肢肿胀消失,8例有不同程度的下肢肿胀,4例复发,随访时血管造影20例,14例血管形态良好,3例呈血栓后综合征表现,3例血管闭塞。结论本方法创伤小,恢复快,疗效好,多数患者能耐受。

Objective To evaluate surgical therapy for deep vein thrombosis （DVT） of the lower extremity. Method Forty-two cases of acute DVT underwent surgical therapy from Jan 2002 to Dec 2004. Vena cave filter was placed contralaterally, diseased femoral vein was opened, thrombus was extracted by compression method, those lodged in iliac veins and femoral veins were extracted by Fogarty catheter. Venous stricture was dilated with ballons, temporary femoral arteriovenous fistula was established which was ligated after 3 months. Result Procedures were successful in 40 cases. Iliac veins stenosis was found in 37 cases and stent was used in 7. 34 cases were followed-up for 3 - 32 monthes. Limb swelling subsided in 26 cases and alleviated in 8 cases. Recurrence was found in 4 cases. Angiography was performed in 20 cases, the result was normal in 14, post vein thrombosis syndrome in 3 and venous conclusion in 3. Conclusion This method has the advantage of less trauma, quick recovery and long-term efficacy.