下肢深静脉血栓后综合征介入治疗的时机及支架应用

Optimal timing and application principle of clinical interventional therapy for post-thrombosis syndrome

目的总结介入治疗下肢深静脉血栓后综合征(PTS)的经验,探讨其最佳治疗时机及应用原则。方法回顾性纳入2010年1月至2017年12月在蚌埠医学院第一附属医院血管外科行下肢PTS介入治疗共102例患者,单纯球囊扩张治疗组49例(主要为2014年以前病例);球囊扩张+支架治疗组53例,其中跨髋关节支架20例。采用Villalta评分、下肢深静脉彩超检查及下肢深静脉造影检查随访评估治疗效果。结果两组介入治疗技术成功率均为100%,单纯球囊扩张组治疗次数为2~3次,球囊扩张+支架治疗组治疗次数仅1次,出院时患者临床症状逐步改善,下肢水肿减轻直至消失,下肢溃疡面逐步愈合。两组患者术后Villalta评分较术前均逐步降低,单纯球囊扩张组平均降低8.76分,球囊扩张+支架治疗组平均降低9.18分;两组比较差异有统计学意义(P<0.01)。随访时间3~72个月,在随访时间3~6个月时,有102例(100%)患者获得随访,在随访时间6~72个月时,有53例(51.96%)患者获得随访。彩超及下肢深静脉造影检查随访结果:髂静脉再狭窄23例,其中单纯球囊扩张组19例(通畅率为61.22%),球囊扩张+支架治疗组4例(通畅率为92.45%);两组比较差异有统计学意义(P<0.01)。结论球囊扩张+支架治疗下肢PTS可以获得满意的近中期临床效果,把握最佳的治疗时机与技术成功率及支架通畅率直接相关,支架的远期通畅性还需进一步临床观察。

ObjectiveTo summarize the experience of clinical interventional therapy for post-thrombosis syndrome (PTS) and to explore the optimal timing and application principle.MethodFrom January 2010 to December 2017, 102 cases of lower extremity PTS who underwent interventional therapy were retrospectively reviewed. Of these, 49 had percutaneous transluminal angioplasty (PTA) alone (PTA group, mainly before 2014) and 53 had PTA plus implantation of stent (PTA+STENT group, of which 20 cases were implanted with trans-hip joint stent). Therapeutic effect was evaluated by using Villalta score, deep venous color Doppler ultrasonography and deep venography of the lower extremities during follow-up.ResultsTechnical success rates of both groups were 100%, respectively. The treatment frequency of PTA group was 2~3 times while PTA+STENT group was only once. Clinical symptoms such as edema and ulcer of the lower extremities of all patients were relieved gradually upon discharge. The Villalta score was improved as well, with a mean score of 8.76 in PTA group and 9.18 in PTA+STENT group (P<0.01) . The follow-up duration was 3~72 months, of which the follow-up rate was 100% (102 cases) in the time of 3~6 months while it decreased to 51.96% (53 cases) during the 6~72 month follow-up duration. Deep venous color Doppler ultrasonography and deep venography revealed iliac venous reocclusion in 23 cases, including 19 in PTA group with stent patency rate of 61.22% and 4 in PTA+STENT group with stent patency rate of 92.45% (P<0.01) .ConclusionPTA+STENT treatment of lower extremity deep vein thrombosis syndrome demonstrates a satisfactory mid-term clinical result, while the optimal treatment timing is related to the technical success rate and stent patency rate. However, the long-term patency of the stent needs further clinical observation.