开放手术结合介入方法治疗急性下肢深静脉血栓形成521例

Hybrid-operation for acute deep venous thrombosis in lower extremities:A clinical analysis of 521 cases

目的探讨开放手术结合多种介入方法(杂交手术)对急性下肢深静脉血栓形成(DVT)的疗效。方法先经健侧安置下腔静脉滤器,再于患侧小切口解剖股静脉。521例急性DVT患者均行Fogarty导管取栓术。单纯取栓38例,取栓联合球囊导管血管成形348例,血管成形联合血管腔内超声消融135例;其中支架置入108例,并对其疗效进行总结。结果髂股段静脉完全开通511例,术中造影示管腔直径≥70.0%;左髂总静脉开口未能开通10例。随访472例(90.6%),平均随访36个月。其中462例完全恢复正常或基本正常,可从事正常工作;10例髂静脉未开通者活动后肢体仍肿胀明显。发生并发症33例(6.3%)。结论上述杂交手术治疗DVT是一种安全、有效的方法。

Objective To evaluate the effect of open surgery combined with multiple interventional methods （hybrid-operation） in the treatment of acute deep venous thrombi （DVT） in lower extremities. Method All 521 cases with DVT were treated by Fogarty embolectomy catheter. Among them, 348 eases underwent pereutaneous transluminal angioplasty （PTA）, 135 cases received PTA and ultrasound ablation,stent-grafts were implanted in 108 cases. The clincial outcome were analysed retrospectively. Result Based on angiography during operation, the obstructed iliofemoral vein received complete recanalization in 511 cases with the postoperative luminal diameter 〉~70%, partial recanalization in 10 cases with the entrance of common iliac vein to inferior vena cava obstructed. Of the 521 cases, 472 cases were followed-up for an average of 36 months after operation and 462 cases received satisfactory results with normal life,the unsuccessful 10 cases still felt swelling pain especially in erect position. Complications occurred in 33 cases. Conclusion Hybrid-operation is a safe and effective method in the treatment of DVT.