急性下肢深静脉血栓形成的外科诊治

The surgical treatment of acute lower extremity deep vein thrombosis

目的探讨急性下肢深静脉血栓形成的手术方法改进。方法选择下肢深静脉血栓发病7d内患者22例,经股静脉切开取栓,由大隐静脉侧支留置导管,术后溶栓治疗及造影检查。结果全部患者于术后3d内肿胀缓解,序贯溶栓治疗10d后,症状完全消失,2例留置导管脱落。20例拔管前造影显示:12例患者左髂静脉狭窄或闭塞,陈旧性血栓附壁,大量侧支循环建立,髂静脉内无新鲜血栓。随访20例,平均12个月,仅2例发生血栓后综合征。结论左髂静脉狭窄或闭塞虽然是左下肢深静脉血栓形成的重要因素,但术中同期处理狭窄或闭塞麻烦、费时,有较多并发症。采取取栓后序贯溶栓治疗效果优良,左髂静脉狭窄或闭塞在无症状情况下可不予处理或二期处理。

Objective To explore the surgical method improvement for the acute deep vein thrombosis of lower limb.Methods We had chosen 22 patients with lower limb deep venous thrombosis in a seven day period,and then removed the thrombus through the femoral vein incision,indwelling catheter by the collateral of great saphenous vein,thrombolytic therapy after surgery and contrast examination.Results The swelling in all patients had been eased within three days after the operation,and then the symptoms disappeared completely after 10 days of sequential thrombolytic therapy,and the two cases of indwelling catheter off.The angiography of 20 patients before extubation had shown the left iliac venous stenosis or obstruction,old mural thrombosis,a large number of collateral circulations,and no fresh iliac vein thrombosis in 12 patients.After an average 12 months of follow up of these 20 patients,only two patients had post-thrombotic syndrome.Conclusion Although the left iliac venous stenosis or obstruction is one of the essential factors contributing to left lower extremity deep venous thrombosis（DVT） of left lower extremity the effect is fine,but the surgery in dealing with them is more problematic,time-consuming,and with more complications.We have taken sequential thrombolytic therapy after a thrombectomy with fine results.The Left common iliac vein stenosis or occlusion without symptoms may not be treated or require a secondary treatment.