重症下肢深静脉血栓形成治疗的临床研究

Clinical study of the treatment of critical deep vein thrombosis of the lower extremity

目的探讨综合应用下腔静脉滤器置入、手术取栓、同时处理Cockett综合征、术后抗凝及溶栓等方法治疗重症下肢深静脉血栓（股青肿）的疗效。方法回顾近10余年9例重症下肢深静脉血栓患者的临床资料。9例中8例行下腔静脉滤器置入、手术取栓、术后抗凝及溶栓,8例中有7例为左下肢深静脉血栓患者,均发现合并不同程度的Cockett综合征,其中2例同时处理Cockett综合征;9例中1例（左下肢深静脉血栓患者）行下肢静脉溶栓术。结果所有患者均无肺栓塞发生,经手术的8例患者除1例（左下肢深静脉血栓患者）术后出现湿性坏疽,被迫截肢外,其余7例均取得较为满意的疗效,挽救了患肢。1例行下肢静脉溶栓的患者死亡。1个月后复查彩超,没有同时处理Cockett综合征的5例中有2例左下肢血栓患者复发血栓,但均未再次发展为股青肿。7例随访1.5～10年,均未发生严重并发症。结论综合应用下腔静脉滤器置入、手术取栓、同时处理Cockett综合征、术后抗凝及溶栓等方法是治疗重症下肢深静脉血栓（股青肿）的有效方法,Cockett综合征是左下肢DVT取栓术后复发的重要原因。

Objective To explore the effect of combined treatment of critical deep vein thrombosis of the lower extremity with inferior vena cava filter placement and thrombectomy,treatment of Cockett syndrome and use of anticoagulation and thrombolysis after thrombectomy.Methods We reviewed the clinical data of 9 patients with critical deep vein thrombosis of the lower extremity treated between 1996 to 2009.Eight patients were treated with inferior vena cava filter placement,thrombectomy,treatment of Cockett syndrome,and anticoagulation and thrombolysis after thrombectomy.Seven patients with critical deep vein thrombosis of the left lower extremity were found to have Cockett syndrome（2 patients were treated）.One patient with critical deep vein thrombosis of the left lower extremity was treated with thrombolysis.Results There were no cases of pulmonary embolism in these patients.Of the 8 patients with thrombectomy,1 patient with critical deep vein thrombosis of the left lower extremity developed gangrene of lower extremity and underwent amputation of the limb.The other lower extremities of 7 patients were salvaged,and the results were satisfactory.One patient died who was treated with thrombolysis.At 1 month after operation,color doppler ultrasound was performed on 5 patient whose Cockett syndrom was not treated,and showed that 2 patients had recurrence of deep vein thrombosis,but none of the 2 patients had recurrence of phlegmasia cerulea dolens.Conclusions The combined treatment of critical deep vein thrombosis of the lower extremity with inferior vena cava filter placement,thrombectomy,treatment of Cockett syndrome and anticoagulation,and thrombolysis after thrombectomy is effective.Cockett syndrome is an important cause for the relapse of deep vein thrombosis of the lower extremity after thrombectomy.