置管溶栓结合髂静脉支架治疗Cockett综合征伴下肢深静脉血栓的近远期疗效

Short-and long-term efficacy of catheter thrombolysis combined with iliac vein stenting for Cockett syndrome and concomitant lower extremity deep vein thrombosis

目的:探讨置管溶栓(CDT)结合髂静脉支架对Cokett综合征伴下肢深静脉血栓(DVT)患者近远期疗效。方法:将2013年1月—2015年1月收治的90例Cockett综合征伴DVT患者用随机数字表法分为观察组和对照组,每组各45例,观察组采用CDT联合支架治疗,对照组采用单独的CDT治疗,对比两组近远期疗效、血管损伤程度及炎症因子变化。结果:两组患者术后疗效差异无统计学意义(H=0.518,P=0.604)。所有患者随访36~40个月,无支架断裂、移位、塌陷、解体或穿破血管现象。观察组再阻塞率低于对照组(11.1% vs. 37.8%,P<0.05)、一次通畅率高于对照组(88.9% vs. 62.2%,P<0.05)。观察组末次随访Villalta评分、VCSS评分低于对照组,CIVIQ评分高于对照组(P<0.05)。两组患者术后血管损伤程度评分、血清TNF-α、IL-10水平较术前明显升高,观察组升高程度明显大于对照组(均P<0.05);观察组再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平明显高于无再阻塞患者(P<0.05),对照组再阻塞与无再阻塞患者血管损伤程度评分、血清TNF-α、IL-10水平差异无统计学意义(P>0.05)。两组不良反应率差异无统计学意义(P>0.05)。结论:CDT联合髂静脉支架植入治疗Cockett综合征伴DVT近期疗效与单独的CDT相似,但远期疗效优于单独的CDT。CDT联合支架植入治疗后发生再阻塞,可能与支架植入刺激炎症因子释放和导致血管损伤有关。

Objective: To investigate the short- and long-term efficacy of catheter-directed thrombolysis (CDT) combined with iliac vein stenting for patients with Cockett syndrome and concomitant lower extremity deep vein thrombosis (DVT). Methods: Ninety patients with Cockett syndrome and DVT admitted from January 2013 to January 2015 were randomly assigned to observation group and control group by the random number table, with 45 cases in each group. Patients in observation group underwent CDT plus stenting, and those in control group underwent CDT alone. The short- and long-term efficacy, severities of vascular injury and changes in inflammatory factors between the two groups were compared. Results: There was no significant difference in postoperative efficacy between the two groups (H=0.518, P=0.604). All patients were followed up for 36 to 40 months, and no stent fracture, displacement, collapse, disintegration or perforation was noted. In observation group, the re-occlusion rate was lower (11.1% vs. 37.8%, P<0.05) and the primary patency rate (88.9% vs. 62.2%, P<0.05) was higher than those in control group. The Villalta score and VCSS score were significantly lower and the CIVIQ score was significantly higher in observation group than those in control group at the last follow-up (all P<0.05). The postoperative vascular injury score and serum TNF-α and IL-10 levels in both groups were significantly increased compared with their preoperative values, but their increasing amplitudes in observation group were significantly greater than those in control group (all P<0.05). The vascular injury score and serum TNF-α and IL-10 levels in patients with re-occlusion were significantly higher than those without re-occlusion in observation group (all P<0.05), which showed no significant differences between patients with and without re-occlusion in control group (all P>0.05). There was no significant difference in incidence of adverse reactions between the two groups (P>0.05). Conclusion: For patients with Cockett syndrome and lower limb DVT, the short-term efficacy of CDT plus iliac vein stenting is similar to that of CDT alone, but its long-term efficacy is better than CDT alone. Re-occlusion after CDT plus stenting may be associated with inflammatory factor release and vascular injury induced by stent implantation.