一体化微创手术治疗髂静脉压迫综合征伴下肢静脉曲张患者疗效观察

Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities

目的:探讨髂静脉压迫综合征伴下肢静脉曲张的一体化微创手术治疗方案的临床效果。方法:回顾性分析2017年1月至2018年1月因髂静脉压迫综合征伴下肢静脉曲张在浙江大学医学院附属第一医院接受左髂静脉支架植入术和下肢静脉射频热消融术患者(11例)的临床资料。通过大隐静脉主干穿刺点入路行左髂静脉支架植入术,而后予以大隐静脉主干的射频热消融术。术后当天开始服用利伐沙班至术后6个月、阿司匹林至术后12个月。患者出院后门诊随访6个月以上,同时分别于2周、2个月、6个月复查下肢静脉、髂静脉多普勒超声或CT血管造影。结果:11例患者均手术成功,术中无并发症发生。随访6个月时,所有患者下肢酸胀缓解率、色素沉着缓解率、皮肤质量改善率和髂静脉支架通畅率均为100%,无静脉曲张复发、髂股静脉血栓及肺栓塞形成。结论:髂静脉压迫综合征伴下肢静脉曲张患者行一体化微创手术治疗方案,具有微创、安全、有效、经济等优势,具有较大的推广价值。

Objective: To analyze the efficacy of integrated minimally invasive surgery for iliac vein compression syndrome with varicose veins of lower extremities. Methods: From January 2017 to January 2018, 11 patients with iliac vein compression syndrome accompanied by varicose veins of lower extremities underwent left iliac vein stent implantation and radiofrequency thermal ablation of lower extremity veins in the First Affiliated Hospital of Zhejiang University School of Medicine. The left iliac vein stent was implanted through the puncture point approach of the main great saphenous vein, and then radiofrequency thermal ablation of the main saphenous vein was performed. Rivaroxaban and aspirin were administered from the day of surgery for 6 months and 12 months, respectively. After discharge, patients were followed up for more than 6 months. The lower extremity veins, iliac veins were reexamined by Doppler ultrasound or CT angiography at 2 weeks, 2 months and 6 months after surgery. Results: The operations were successfully performed in 11 patients, and no complication was observed during the operation. The rates of soreness and swelling remission, pigmentation and skin quality improvement, and the iliac vein stent patency were 100%. No varicose vein recurrence, iliofemoral vein thrombosis and pulmonary embolism were found. Conclusion: Integrated minimally invasive surgery is safe, effective and less invasive for iliac vein compression syndrome with varicose veins of lower extremities.