大隐静脉高位结扎剥脱术后深静脉血栓形成12例分析

Deep venous thrombosis after greater saphenous vein ligation and stripping

目的探讨大隐静脉高位结扎剥脱术后深静脉血栓形成（deep venous thrombosis，DVT）的临床特点、病因及预防措施。方法回顾性分析收治的12例行大隐静脉高位结扎剥脱术后合并DVT患者的临床特点及诊疗方法，并讨论病因及预防措施。结果12例DVT患者中7例为中央型，2例为周围型，3例为混合型。DVT合并肺栓塞2例。lO例中央型和混合型DVT的肢体增粗症状严重，肢围差距均〉5cm。9例行下腔静脉滤器（inferior vena cava fiher，IVCF）保护下的胭静脉置管溶栓术（catheter-directed thrombolysis，CDT）治疗，其中1例介入造影过程中发现左股静脉突然中断，中转手术行股静脉探查修复术、CDT及髂静脉支架植入术；8例发现左髂静脉压迫综合征的影像学表现，其中6例在CDT治疗后行髂静脉支架植入术。1例结合术前彩超及造影所见考虑为右大隐静脉残端血栓蔓延至股静脉，行股静脉切开取栓治疗。2例周围型DVT行抗凝为主的综合性药物治疗。本组12例DVT患者均取得较好的近期疗效。结论手术损伤股静脉、大隐静脉残端过长、左髂静脉压迫综合征是大隐静脉高位结扎剥脱术后DVT的临床常见原因。术前明确下肢慢性静脉功能不全的病变类型、术中仔细操作、术后早期下床活动至关重要。

Objective To report deep venous thrombosis （DVT） after greater saphenous vein ligation and stripping and to evaluate diagnosis, treatment and prophylaxis. Methods The clinical characteristics, diagnosis and treatment of 12 inpatients with postoperative DVT were analyzed retrospectively. Results Of these 12 cases there were 7 eases of central type DVT,2 cases of peripheral DVT,and 3 cases of mixed type DVT. Secondary pulmonary embolism was complicated in 2 cases. Clinical symptoms in these 10 cases of proximal DVT were all severe. Catheter-directed thrombolysis（CDT） through the ipsilateral popliteal vein with protective IVCF was applied for these 10 cases. Of 10 cases, femoral vein was found ligated in 1 case, which was repaired under open surgery. Residual greater saphenous vein thrombus extending into deep vein was proved and managed by successful thrombolectomy in one case. Cockett syndrome were found as the causes in the other 8 cases, 6 cases were treated with balloon dilatation angioplasty and endovascular stenting of the iliac vein. The 2 cases of with distal DVT were treated by anticoagulation therapy. All patients were cured. Conclusions Cockett syndrome, femoral vein injury and too long residual greater saphenous vein are common causes of DVT after greater saphenous vein ligation and tripping. Careful selection of cases, correct diagnosis, standard operative manipulation, early ambulation were all important in the prevention of DVT after great saphenous vein varix procedure.