股静脉内膜剥脱联合介入手术在中重度血栓形成后综合征中的应用

Femoral venous endophlebectomy and interventional therapy of moderate-to-severe post-thrombotic syndrome

目的 探讨股静脉内膜剥脱联合腔内介入手术在治疗中重度血栓形成后综合征(PTS)中的作用.方法 回顾性分析2013年1月至2015年6月使用股静脉内膜剥脱联合髂静脉球扩支架术治疗的26例中重度PTS患者的临床资料.术前使用CEAP分级的C分级和Villalt评分对患者严重程度分级,术前、术后1个月和术后6个月分别使用临床表现严重程度评分(VCSS)和生命质量调查表(CIVIQ)对患者症状、体征及生活质量受影响情况进行评估.术后6个月和1年随访时使用多普勒超声评估干预静脉通畅情况.结果 除1例无法剥脱外,其余25例患者手术成功,未出现围手术期心脑血管意外.2例术后出现腹股沟手术切口明显血肿,再次手术清除血肿止血后愈合;1例术后切口淋巴漏,对症处理后愈合.术后随访6～24个月,所有干预血管均通畅.术后1个月和6个月VCSS评分和CIVIQ评分均较术前明显改善(P＜0.05).结论 股静脉内膜剥脱联合髂静脉球扩支架术治疗中重度PTS患者疗效显著,但具体的手术细则应根据患者具体情况制定.

Objective To discuss the methods of endophlebectomy and interventional therapy for moderate-to-severe post-thrombotic syndrome (PTS).Methods The data of 26 cases with PTS,who underwent endophlebectomy and interventional therapy from January 2013 to June 2015,were reviewed.The severity of PTS preoperatively was evaluated by CEAP scale and Villalt scores.According to chronic venous insufficiency questionnaire (CIVIQ) and venous clinical severity score (VCSS),quality of life and severity of patient was evaluated befroe and after operation 1-and 6-month.Duplex scan was conducted at postoperative 6-and 12-month to monitor the patency of iliofemoral vein.Results All the operations were successfully treated besides one was failure.No perioperative cardiocerebral events were noted in all patients.After operation,2 cases appeared incisional subcutaneous hematoma and recovered after removing hematoma and stopping bleeding.Lymphangial leaks occurred in 1 case,and healed through symptomatic treatment.During the follow-up time of 6-24 months,all iliofemoral veins were patent.Compared with preoperation,VCSS and CIVIQ scores improved significiantly at 1-and 6-month postsperatively (P＜0.05).Conclusion Femoral endophlebectomy and interventional therapy is a safe and efficient method for the patients with moderate-tosevere PTS,but individualized treatment should be considered for patients with PTS.