急性重症下肢深静脉血栓形成的外科治疗

Treatment of severe acute deep venous thrombosis in lower extremity

目的探讨急性重症下肢深静脉血栓形成（DVT）的外科治疗方法与效果。方法回顾性分析了2002年1月至2008年12月首都医科大学宣武医院血管外科治疗18例急性重症DVT患者，均有肿胀和肢体疼痛；16例伴有皮肤颜色青紫（1例小腿皮肤坏疽），2例伴有皮肤苍白；10例出现下肢足背动脉搏动减弱，8例足背动脉搏动正常；血管彩色多普勒超声显示：下肢深、浅静脉均有血栓形成。1例因患肢坏疽行膝上截肢手术。17例采用手术切开取栓，仅3例单纯采用手术切开取栓术，5例加用大隐静脉耻骨上转流术，6例加用人工血管耻骨上转流术，3例采用髂静脉松解成形术。结果手术死亡1例（5．6％）。下肢肿胀消失7例（41．2％），明显减轻10例（58．8％）。除截肢的1例外其余患者皮肤颜色均基本恢复正常，动脉搏动也恢复正常。16例患者被随访，随访率为94．1％；随访时间为3—82个月，平均为34个月。患肢肿胀完全消失5例，占31．3％；肿胀明显减轻者8例，占50％；肿胀复发3例，占18．7％。复发的3例中，1例于术后9个月死于晚期恶性肿瘤，2例分别于35个月和48个月后因移植血管桥内膜增生导致闭塞而复发。结论外科手术取栓是治疗急性重症DVT的有效方法；当髂静脉受压，耻骨上转流是一种可选择的有效方法。

Objective To explore the method and effectiveness of treatment for severe acute deep venous thrombosis （DVT） in lower extremity. Methods Eighteen patients with severe acute DVT treated in our hospital from January 1,2002 to December 31,2008 were retrospectively analysed. All the patients had limb edema and pain, sixteen had limb cyanochroia （ one had calf skin ulcer and foot gangrene）, two had limb pallor, ten had weakened dorsalis pedis artery pulsation, eight had silent dorsalis pedis artery pulsation. Colour Doppler ultrasonography revealed DVT and superficial venous thrombosis in all diseased limbs. One patient underwent above knee amputation for limb gangrene. Seventeen underwent surgical thrombectomy, of which three were simple thrombectomy, five were supplemented with suprapubic saphenous vein bypass, six with suprapubic PTFE graft bpass, three with iliac vein lysis angioplasty. Results One patient died （5.6%） on the third day after surgery . Limb edema relieved in seven patients （41.2%） , reduced in ten patients （58. 8% ）. All diseased limbs regained normal artery pulsation and skin appearance except for one limb amputated. Sixteen patients （94. 1% ） were followed up by a mean of 34 months. Limb edema disappeared in five patients （31.3%） , reduced in eight patients （50%） , recurrent in three patients （ 18. 7% ）. Among three recurrent patients, one died of malignant tumor 9 months after operation, two had their graft occluded resulting from intimal hyperplasia. Conclusions Surgical thrombeetomy is an effective method for treating severe acute DVT in lower extremity.