置管溶栓术联合髂股静脉支架植入治疗髂静脉压迫综合征合并急性下肢深静脉血栓的效果

Effect of catheter directed thrombolysis combined with iliofemoral vein stent implantation in treatment of Cockett syndrome complicated with acute deep venous thrombosis of lower extremity

目的观察置管溶栓术(CDT)联合髂股静脉支架植入治疗髂静脉压迫综合征(Cockett综合征)合并急性下肢深静脉血栓(DVT)的效果。方法回顾性分析93例Cockett综合征合并急性下肢DVT患者的资料,根据手术方式的不同分为CDT组47例(采用CDT治疗)和联合组46例(采用CDT联合髂股静脉支架植入治疗),比较术前与术后1个月时2组炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平,并比较2组患者的血栓清除率、术后并发症发生率和复发情况。结果联合组血栓清除率分级情况优于CDT组,复发率低于CDT组,差异有统计学意义(P<0.05);CDT组手术前后IL-6、CRP水平比较,差异无统计学意义(P>0.05);联合组术后1个月时IL-6、CRP水平均高于术前,且高于CDT组,差异有统计学意义(P<0.05);2组并发症总发生率比较,差异无统计学意义(P>0.05)。结论Cockett综合征合并急性下肢DVT患者应用CDT联合髂股静脉支架植入治疗利于清除血栓,可降低复发率,且安全性好,但联合治疗可能会介导炎症反应发生,增大新血栓发生风险,术后应积极实施合理的抗炎治疗。

Objective To observe the effect of catheter directed thrombolysis(CDT)combined with iliofemoral vein stent implantation in treatment of Cockett syndrome complicated with acute deep venous thrombosis(DVT)of lower extremity.Methods The data of 93 patients with Cockett syndrome complicated with acute DVT was retrospectively analyzed and collected.According to the operative methods,they were divided into CDT group(47 cases,treated with CDT)and combined group(46 cases,treated with CDT combined with iliofemoral vein stent implantation).The thrombus clearance rate,the incidence of postoperative complications and recurrence of the two groups were compared.The inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)]in the two groups before and 1 month after operation were compared.Results The grading of clearance rate of thrombus in the combined group was better than that in the CDT group,and the recurrence rate in the combined group was lower than that in the CDT group(P<0.05).There were no significant differences in the levels of IL-6 and CRP in CDT group before and after operation(P>0.05).The levels of IL-6 and CRP in the combined group at 1 month after operation were higher than those before operation and the CTD group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion CDT combined with iliofemoral vein stent implantation in the treatment of patients with Cockett syndrome complicated with acute DVT is helpful to remove thrombus,reduce the recurrence rate,and has higher safety.However,the combined treatment may mediate inflammatory reaction and increase the risk of new thrombosis.Therefore,reasonable anti-inflammatory treatment should be carried out actively after operation.