髂静脉压迫综合征继发下肢静脉溃疡治疗的临床研究

Clinical study on the treatment of lower extremity venous ulcer secondary to iliac vein compression syndrome

目的探讨髂静脉压迫综合征(IVCS)继发下肢静脉溃疡的愈合情况及诊治体会。方法收集2018年4月至2021年9月就诊于上海市中西医结合医院的54例IVCS合并下肢静脉溃疡患者的临床资料,观察患者的病变长度、溃疡愈合情况、凝血功能指标[D-二聚体、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(Fib)]等,分析腔内治疗IVCS后的溃疡愈合情况。结果所有患者中,单纯左侧髂静脉受压患者的影像学表现主要为左侧髂总静脉被前方的右髂总动脉及后方腰椎压迫引起狭窄,术中数字减影血管造影(DSA)下可见管腔狭窄、血液流速缓慢或大量侧支循环;部分患者左侧髂静脉完全狭窄,可见血流通过侧支循环至右侧髂静脉回流至下腔静脉。所有患者中,左侧髂静脉共植入支架89枚,平均病变长度为115.56 mm;右侧髂静脉共植入支架19枚,平均病变长度为62.63 mm。髂静脉开通成功率为100%,结合介入术后创面处理,仅有1例患者创面未愈合,主要与患者溃疡面积过大、病程过久有关,其余患者的创面均已愈合。术后复查凝血功能及下肢静脉超声,无患者发生下肢深静脉血栓形成。围手术期无死亡患者,无肾功能不全等严重并发症发生。术后当天,患者的D-二聚体、Fib水平均较术前升高,差异均有统计学意义(P<0.05)。术后当天与术前的APTT、INR、TT、PT比较,差异均无统计学意义(P>0.05)。结论对于IVCS继发下肢静脉性溃疡患者,早期解除髂静脉压迫,可缩短愈合周期,减少溃疡复发,增加患者获益。

Objective To investigate the healing,diagnosis and treatment of lower extremity venous ulcer secondary to iliac vein compression syndrome(IVCS).Method The clinical data of 54 patients with IVCS complicated with lower extremity venous ulcer treated in Shanghai TCM-Integrated Hospital from April 2018 to September 2021 were collected.The characteristics of lesion length,ulcer healing and coagulation function[D-dimer,activated partial thromboplastin time(APTT),international normalized ratio(INR),thrombin time(TT),prothrombin time(PT),fibrinogen(Fib)]were observed,and the ulcer healing after intracavitary treatment of IVCS was analyzed.Result In all patients,the imaging manifestations of patients with simple left iliac vein compression were mainly that the left common iliac vein was compressed by the anterior right common iliac artery and the posterior lumbar spine,and the lumen stenosis,slow blood flow or a large number of collateral circulation were observed under intraoperative digital subtraction angiography(DSA).In some patients,the left iliac vein was completely narrow,and the blood flow can be seen circulating to the right iliac vein through collateral branches and flowing back to the inferior vena cava.In all patients,89 stents were implanted into the left iliac vein,with an average lesion length of 115.56 mm;a total of 19 stents were implanted into the right iliac vein,with an average lesion length of 62.63 mm.The success rate of iliac vein opening was 100%.Combined with the wound treatment after interventional surgery,only one patient's wound did not heal,which was mainly related to the excessive ulcer area and long course of disease,and the wounds of other patients had healed.Blood coagulation function and lower extremity venous ultrasound were rechecked after operation.No patient had lower extremity deep venous thrombosis.There was no death or serious complications such as renal insufficiency during the perioperative period.On the day after operation,the levels of D-dimer and Fib were higher than those before operation(P<0.05).There was no significant difference in APTT,INR,TT and PT between the day after operation and that before operation(P>0.05).Conclusion For patients with lower extremity venous ulcer secondary to IVCS,early release of iliac vein compression can shorten the healing cycle,reduce ulcer recurrence and increase the benefits of patients.