下肢PTS患者术后静脉支架通畅率及危险因素

Postoperative patency rate of venous stent and risk factors in patients with deep venous post-thrombotic syndrome of lower extremity

目的探讨下肢深静脉血栓形成后综合征(PTS)患者术后静脉支架通畅率及危险因素。方法回顾性选取2021年1月至2023年1月烟台市莱阳中心医院和烟台毓璜顶医院收治的106例下肢PTS患者作为研究对象。其中男65例,女41例;年龄29~79(58.71±9.64)岁。所有入组患者均接受静脉球囊扩张联合支架植入术治疗,术后对患者进行1年随访,评估静脉支架通畅情况。根据静脉支架通畅情况将患者分为通畅组与不通畅组。比较两组一般资料,采用logistic回归分析影响静脉支架通畅的危险因素。采用独立样本t检验、χ^(2)检验和秩和检验。结果经统计,在106例下肢PTS患者中,术后1年静脉支架通畅88例,通畅率为83.02%(88/106)。logistic回归分析显示,BMI、存在静脉曲张、支架数量均为静脉支架通畅的危险因素(OR=2.349、3.509、2.604,P=0.002、0.002、0.007),而血栓清除分级、抗凝药物-利伐沙班治疗、抗凝治疗时长、接受抗血小板治疗、接受压力治疗均为静脉支架通畅的保护因素(OR=0.400、0.335、0.460、0.316、0.356,P=0.016、0.028、0.003、0.028、0.016)。结论下肢PTS患者静脉支架通畅率受多种因素影响,控制体重、改善静脉曲张、有效清除血栓、合理选择抗凝药物、抗凝6个月以上、术后行抗血小板治疗和压力治疗,或许可以有效提高患者静脉支架通畅率,保障治疗效果。

Objective To investigate the postoperative patency rate of venous stent and risk factors in patients with deep venous post-thrombotic syndrome(PTS)of lower extremity.Methods A total of 106 patients with lower extremity PTS admitted to Yantai Laiyang Central Hospital and Yantai Yuhuangding Hospital from January 2021 to January 2023 were retrospectively selected as the study objects.There were 65 males and 41 females,aged 29-79(58.71±9.64)years.All enrolled patients were treated with venous balloon dilation combined with stent implantation,and were followed up for 1 year after surgery to assess the patency of venous stent.According to the patency of venous stent,they were divided into a patency group and a non-patency group.The general information of the two groups were compared,and logistic regression analysis was used to analyze the risk factors affecting the patency of venous stent.Independent sample t test,χ^(2)test,and rank sum test were used.Results According to statistics,among the 106 PTS patients of lower extremity,there were 88 cases of venous stent patency within 1 year after operation,and the patency rate was 83.02%(88/106).Logistic regression analysis showed that BMI,having varicose veins,and number of stents were risk factors for stent patency(OR=2.349,3.509,and 2.604,P=0.002,0.002,and 0.007);thrombus clearance grading,anticoagulant drug-rivaroxaban treatment,duration of anticoagulant treatment,receiving antiplatelet therapy,and receiving compression therapy were all protective factors for stent patency(OR=0.400,0.335,0.460,0.316,and 0.356,P=0.016,0.028,0.003,0.028,and 0.016).Conclusions The patency rate of venous stent in patients with lower extremity PTS is affected by many factors.Controlling body weight,improving patients'varicose veins,effectively removing thrombus,reasonably choosing anticoagulant drugs as well as anticoagulation for more than 6 months,and performing antiplatelet therapy and compression therapy after surgery may be able to effectively improve the patency rate of venous stent and safeguard the therapeutic effect.