介入联合手术治疗急性髂股静脉血栓形成

Intervention combined surgery for the treatment of acute iliofemoral vein thrombosis

目的分析介入联合手术治疗（interventioncombinedsnrgicaltherapy，IST）急性髂股静脉血栓形成（deepveinthrombosis，DVT）的效果。方法回顾性分析行介入导管取栓溶栓（catheter．directedpharmacomechanicalthrombolysis，CDPT）和IST治疗的61例急性髂股DVT患者的临床资料。结果61例患者中CDPT组47例，IST组14例。IST组中双侧髂股DVT3例，1个月内有骨科、妇科手术史者5例，逆行进入患侧髂股静脉困难者3例。术后出院时，CDPT组水肿缓解有效率为93．6％，IST组为94．1％；CDPT组1例患者出现黑便，IST组1例患者出现切口血肿。术后14～37个月随访，CDPT组水肿缓解有效率为85．0％，IST组为85．7％，两组比较差异无统计学意义（x^2=0．004，P=0．948）；术后CDPT组1例患者出现足靴区色素沉着；BUS检查CDPT组静脉通畅率为52．6％，IST组为84．6％，两组比较差异有统计学意义（x^2=4．157，P=0．041）。结论IST与CDPT比较，水肿缓解率相似，血栓复发率较低。在双侧急性髂股DVT、具溶栓禁忌证或逆行进入患侧髂股静脉困难的情况下，应考虑采用IST治疗急性髂股DVT。

Objective To compare two treatment methods for acute iliofemoral vein thrombosis： catheter-directed pharmacomechanical thrombolysis （ CDPT, 47 cases） and intervention combined surgical therapy（IST, 14 cases）. Methods This study includes 61 patients of acute iliofemoral vein thrombosis treated by CDPT or IST. All discharged cases were followed up by telephone for a period of 14 -37 months. Results Among the 61 patients （64 extremities）, 47 （forty-seven extremities） treated by CDPT, and 14 cases （seventeen extremities） treated by IST. The IST group included three patients of bilateral iliofemoral vein thrombosis, five patients on postoperative status within one month, and three patients in which the iliofemoral vein was not accessible. When discharged from hospital, the effective rate of edema relief is 93.6% in CDPT group while that is 94. 1% in IST group; Melena occurred in one patient of CDPT group and incision hematoma occurred in one patient of IST group. According to the results of 14 - 37 months follow-up, the effective rate of edema relief is 85.0% in CDPT group while that is 85. 7% in IST group （X^2 = 0. 004 and the P = 0. 948）. Calf pigmentation occurred in only one patient of CDPT group. The patency rate of vein by BUS examination is 52. 6% in CDPT group while that is 84.6% in IST groupX^2 = 4. 157, P = 0. 041 ）. Conclusions Comparing with CDPT group, IST group has the similar effective rate of edema relief, but has higher potency rate of iliofemoral vein. In case of bilateral acute iliofemoral vein thrombosis, in patients in whom thrombolysis is contraindicated, or when the iliofemoral vein is not accessible, IST is the treatment of choice for acute iliofemoral vein thrombosis.