下肢深静脉血栓手术取栓术中Cockett综合征的处理(附173例报告)

Treatment of Cockett syndrome during thrombectomy of patients with deep vein thrombosis of lower extremity(report of 173 cases)

目的总结173例下肢深静脉血栓合并Cockett综合征患者的治疗方法及预后情况。方法283例左下肢深静脉血栓手术取栓患者中，共发现Cockett综合征173例。其中108例患者一次手术取栓成功；38例左髂总静脉短段闭塞者行闭塞段静脉切除，端-端吻合髂总静脉；27例患者再次静脉切开取栓，并采取股静脉-下腔静脉原位移植术12例，健侧大隐静脉-股静脉交叉转流移植术（Palma手术）15例。结果96例（55．49％）患者于术后1～3d患肢肿胀消退并接近健侧；32例（18．49％）于术后5～7d后肢体肿胀消退；18例（10．41％）肢体水肿消退较慢。27例再次取栓患者术后恢复良好。全组病例得到随访者146例，随访率84．39％，随访期间患肢症状改善满意。结论下肢深静脉血栓合并Cockett综合征患者手术取栓过程中，需要根据髂总静脉的闭塞情况作出相应的处理，才能达到理想的手术效果。

Objective To evaluate the surgical treatment of Cockett syndrome with deep vein thrombosis of lower extremity（DVT）. Methods There were 173 cases of Cockett syndrome among 283 patients with DVT. One hundred and eight cases received just only once successfully thrombectomy;Resection and reconstruction were performed in 38 patients ;27 cases received second thrombectomy, and iliocaval bypass for 12 patients ,palma procedure for 15 patients. Results Ninty - six patients demonstrated obvious edema relief in three days after thrombectomy ;The edema of thirty - two patients alleviated in 5 to 7 days after thrombectomy. Eighteen cases achieved edema relief slowly. 27 second thrombectomy cases demonstrated edema relief quickly. One hundred and forty - six patients were followed up, and during the follow - up period, all the patients achieved good results. Conclusions Cockett syndrome with DVT during thrombectomy should choose different treatment according to the straitness degree of left common iliac vein.