经股静脉切开行下肢深静脉取栓术的安全性与易行性

Safety and Feasibility of Femoral Vein Thrombectomy for Deep Vein Thrombosis in the Lower Limbs

目的探讨对急性期下肢深静脉血栓形成行股静脉切开取栓术的安全性与易行性。方法2003年6月～2006年8月对43例下肢深静脉急性血栓形成,急诊放置下腔静脉滤器行股静脉切开下肢深静脉取栓术,术后辅以抗凝、区域性溶栓。结果手术时间55～115 min,平均92.6 min。术中出血量100～1000 ml,平均384.6 ml,仅4例接受输血。术中5例发生一过性血压波动,很快恢复。术中及术后均无肺栓塞发生。术后5例发生腹股沟切口淋巴漏,均1周内愈合;1例老年患者卧床性肺炎,治疗后痊愈;无其他片发症发生。术后患肢肿痛缓解迅速,双下肢周径差值分别由术前的5.5 cm(中位数,膝上)、4.0 cm(中位数,小腿)降为1.5 cm(Z=-5.345,P=0.000)、1.0 cm(Z=-5.461,P=0.000)。32例随访6个月,未见血栓复发。结论经股静脉切开深静脉取栓术操作易行,安全,术后早期症状缓解明显。对于急性期累及髂股静脉的较严重的下肢深静脉血栓可以考虑手术取栓。

Objective To investigate the safety and feasibility of femoral vein thrombectomy for patients with acute deep vein thrombosis in the lower limbs. Methods During June 2003 to August 2006, a succession of 43 patients with acute deep vein thrombosis in the lower extremities received femoral vein thrombectomy in our hospital. An inferior vena cava filter was employed before the operation. Anticoagulation and regional thrombolysis were taken postoperatively. Analyse the data of operation procedure, curative effect and complications. Results The operation time ranged from 55 to 115 minutes with a mean of 92.6 minutes. Four of the patients received blood transfusion during the operation. The mean blood loss was 384.6 ml （100 to 1000 ml）. Five patients showed transient fluctuation of blood pressure during the surgery. None of the patients had pulmonary embolism during and after the operation.＇ Five patients developed lymph leakage from the incision at the inguinal area, and was cured in 1 week. One aged patient suffered from postoperative postatic pneumonia and was cured before being discharged; no other complications were found in this series. The thrombectomy achieved good outcomes in our patients. The edema and pain in the lower limbs were relieved quickly after the operation, the difference between the circumferences of the two legs decreaed from a median ofS. 5 cm （thigh） and 4.0 cm （crus） to 1.5 cm and 1.0 cm （ Z = - 5. 345, P = 0. 000 and Z = - 5. 461 , P =0. 000 ） , respectively. 32 of the patients received re-examination 6 months postoperation, none of them showed recurrent thrombosis. Conclusions Femoral vein thrombectomy is feasible and safe for serious acute deep vein thrombosis in the iliac and femoral veins. Patients can recover quickly after the operation.