早期减容对左髂静脉压迫综合征伴急性髂静脉血栓的治疗效果

Therapeutic effect of early volume reduction on left iliac vein compression syndrome with acute iliac vein thrombosis

目的 探讨早期机械性血栓抽吸减容对左髂静脉压迫综合征伴急性髂静脉血栓的治疗效果。方法 收集2018年10月至2022年10月青岛市市立医院收治的58例左髂静脉压迫综合征伴急性髂静脉血栓患者的临床资料,根据治疗方法的不同将患者分为观察组[n=28,直接行经皮机械性血栓清除术(PMT)进行减容,开通髂静脉后再放置髂静脉支架]和对照组(n=30,Ⅰ期仅放置溶栓导管进行溶栓,Ⅱ期行PMT后放置髂静脉支架)。比较两组患者的治疗情况,包括溶栓时间、尿激酶总量、血栓清除率、溶栓并发症发生情况,以及术后6个月的患肢周径变化率、血栓后综合征(PTS)评分、髂静脉通畅率。结果 58例患者均成功开通狭窄髂静脉。观察组患者的溶栓时间明显短于对照组患者,尿激酶总量、溶栓并发症发生率均明显少于对照组患者,患肢周径变化率明显高于对照组患者,差异均有统计学意义(P<0.01);两组患者的血栓清除等级、术后6个月PTS评分、术后6个月髂静脉通畅率比较,差异均无统计学意义(P>0.05)。两组患者治疗后均未出现严重并发症。结论 在左髂静脉压迫综合征伴急性髂静脉血栓的治疗过程中,早期机械性血栓抽吸减容能够减少溶栓时间与溶栓剂量,减少溶栓并发症的发生,提高肢体周径变化率,快速缓解临床症状,但在远期通畅率方面,二者并无差别。

Objective To investigate the efficacy of early mechanical thrombus volume reduction in the treatment of left iliac vein compression syndrome with acute iliac vein thrombosis.Method The clinical data of 58 patients with left iliac venous compression syndrome with acute iliac vein thrombosis who were hospitalized in the Qingdao Municipal Hospital from October 2018 to October 2022 were collected.According to different treatment methods,the patients were divided into the observation group[n=28,who underwent percutaneous mechanical thrombectomy(PMT)directly for volume reduction,and then opened iliac vein and placed iliac vein branch]and the control group(n=30,treated with catheter-directed thrombolysis in stage I,and iliac vein stents were placed after PMT in stage II).The treatment outcomes of two groups of patients were compared,including thrombolysis time,total dosage of urokinase,thrombus clearance,incidence of thrombolytic complications,as well as the change rate of affected limb circumference, post-thrombosis syndrome (PTS) scores, and iliac vein patency rate at 6 months after surgery. Result The stenosis iliac vein was successfully opened in all 58 patients. The thrombolysis time of the observation group was significantly shorter than that of the control group, the total dosage of urokinase and the incidence of thrombolysis complications were significantly lower than those of the control group, the change rate of affected limb circumference was significantly higher than that of the control group, and the differences were statistically significant (P<0.01). There was no statistically significant difference in the thrombus clearance level, PTS score 6 months after surgery, and iliac vein patency rate 6 months after surgery between the two groups of patients (P>0.05). Both groups of patients did not experience serious complications after treatment. Conclusion In the treatment of left iliac vein compression syndrome with acute iliac vein thrombosis, early mechanical thrombus volume reduction can reduce thrombolysis time and amount of thrombolytic agent, reduce the occurrence of thrombolytic complications, improve the rate of limb circumference change, and quickly alleviate clinical symptoms, but there is no difference in long-term patency rate.