下肢深静脉血栓手术取栓术中Cockett综合征的处理（附173例报告）

目的总结173例下肢深静脉血栓合并Cockett综合征患者的治疗方法及预后情况。方法283例左下肢深静脉血栓手术取栓患者中,共发现Cockett综合征173例。其中108例患者一次手术取栓成功;38例左髂总静脉短段闭塞者行闭塞段静脉切除,端-端吻合髂总静脉;27例患者再次静脉切开取栓,并采取股静脉-下腔静脉原位移植术12例,健侧大隐静脉-股静脉交叉转流移植术(Palma手术)15例。结果96例(55.49%)患者于术后1~3d患肢肿胀消退并接近健侧;32例(18.49%)于术后5~7d后肢体肿胀消退;18例(10.41%)肢体水肿消退较慢。27例再次取栓患者术后恢复良好。全组病例得到随访者146例,随访率84.39%,随访期间患肢症状改善满意。结论下肢深静脉血栓合并Cockett综合征患者手术取栓过程中,需要根据髂总静脉的闭塞情况作出相应的处理,才能达到理想的手术效果。     

介入联合手术治疗下肢深静脉血栓后综合征

目的：探讨下肢深静脉血栓后综合征的外科治疗方法.方法：下肢深静脉血栓后综合征20例,采用球囊扩张左股总及髂静脉狭窄段、置入支架并做临时性股动静脉瘘方法治疗,其中10例同时行大隐静脉结扎抽剥术.结果：所有病例介入及手术取得成功.出院时14例肢体肿胀明显缓解,4例轻度肿胀,2例缓解不明显.随访15例（3～24个月）,13例肿胀消退,5例足靴区溃疡愈合,2例未愈.结论：多数下肢深静脉血栓后综合征患者的髂静脉病变是以狭窄为主,可以通过介入的方法治疗.本方法创伤小、近期疗效较好.     

介入联合手术治疗急性下肢深静脉血栓形成1

目的：探讨下肢深静脉血栓形成的手术治疗方法。方法：急性下肢深静脉血栓形成14例，先经健侧股静脉置入下腔静脉滤器，再切开患侧股静脉，远端血栓以挤压法驱出，近端髂股静脉内血栓以Fogarty球囊取出；球囊扩张左髂静脉狭窄11例，其中5例放置支架；最后做临时性股动静脉瘘。结果：14例手术成功。13例随访2。30个月，其中12例患肢肿胀消退，1例复发：结论：本方法创伤小，恢复快，疗效好，多数患者能耐受。下腔静脉滤器应以临时性为首选。     

超声消融球囊扩张联合动静脉瘘治疗下肢深静脉血栓

目的：探讨超声血栓消融、球囊扩张联合动静脉瘘冶疗下肢深静脉血栓形成的临床疗效。方法：选择严重的亚急性、慢性期下肢深静脉血栓36例，先经健侧股静脉置入下腔静脉滤器，再经患侧股静脉用Acolysis超声消融器进行血栓消融、球囊导管扩张髂静脉病变、股动静脉间临时性动静脉瘘术治疗。结果：30例消融顺利，造影见有髂静脉狭窄29例，用球囊导管扩张；11例置入永久性滤器，19例患者置入临时性滤器。25例获随访3～30个月，其中19例患肢肿胀消退，无血栓后综合征表现；另6例导管穿透血管壁治疗失败。结论：本方法创伤小、恢复快，多数患者能耐受、效果良好；下腔静脉滤器以临时性为首选，放置时间越短越好。     

髂静脉压迫综合征的外科治疗

目的：探讨髂静脉压迫综合征的外科治疗方法。方法：手术治疗髂静脉压迫综合征30例，其中行经腹左髂静脉松解、右髂动脉后置吻合术7例，左髂静脉切开成形、右髂动脉后置吻合术18例，左髂静脉病变段切除、人工血管原位移植术5例；同时行左股静脉瓣膜缩窄及大隐静脉高位结扎剥脱术20例。结果：无手术死亡．患肢肿胀均有不同程度的缓解，原有肢体溃疡愈合或好转。随访21例，随访时间2～36月(平均23月)，效果满意。结论：对髂静脉压迫综合征应采取积极的手术治疗以恢复血流通畅，手术效果良好。     

手术取栓、挤压驱栓联合介入治疗急性下肢深静脉血栓65例临床分析

目的 探讨急性下肢深静脉血栓合理的治疗方式.方法 自2006年3月至2009年9月我院共收治下肢深静脉血栓患者65例,病变累及左侧者48例,右侧者15例,双侧者2例,首先植入下腔静脉滤器,再取患侧股部切口,髂静脉血栓以Fogarty管取出,远侧静脉内血栓以挤压的方法驱出,球囊扩张联合支架置入治疗髂静脉狭窄.结果 30例存在左侧髂静脉狭窄,扩张后26例髂静脉狭窄回缩达50%以上,置入支架.病人无死亡和肺动脉栓塞.出院时,患者治疗效果良好,46例肢体肿胀消失,19例轻度肿胀.随访60例,时间3-30个月,无肺栓塞的发生,55例肿胀消失,5例轻度肿胀.结论 本方法是安全有效的治疗下肢深静脉血栓的手术方式.     

继发于血栓性浅静脉炎的急性下肢深静脉血栓的一期外科治疗

目的:探讨在继发于血栓性浅静脉炎的下肢深静脉血栓的治疗方法中,一期处理血栓性浅静脉炎及下肢深静脉血栓的初步经验.方法:对5例由肢体血栓性浅静脉炎引发的急性下肢深静脉血栓的患者,依次采用下腔静脉滤器植入术、股静脉切开取栓术及大隐静脉高位结扎加浅静脉点式剥脱术的联合手术治疗.结果:5例患者于术中均证实深静脉血栓由浅静脉血栓蔓延而来.术后肢体肿胀明显消退;术后随访1～6个月,肢体肿胀未再次出现.结论:一期手术治疗继发于血栓性浅静脉炎的下肢深静脉血栓疗效确切,安全可靠.     

急性髂股静脉血栓形成患者下肢深静脉血栓形成后综合征的影响因素分析

目的:探讨急性髂股静脉血栓形成患者并发下肢深静脉血栓形成后综合征（PTS）的危险因素及预测模型。方法:回顾性研究。纳入上海交通大学医学院附属第九人民医院血管外科2017年1月—2018年6月233例急性髂股静脉血栓形成患者临床资料。其中,男135例、女98例,年龄17~85（58.69±15.73）岁,行腔内治疗200...     

严重髂股静脉血栓形成解剖因素及临床治疗

目的:探讨髂股静脉血栓形成的解剖因素及Fogarty导管取栓术并发症的防治。方法:对20例严重下肢深静脉血栓形成的病人,Fogarty取栓导管分别取出血管的血栓时,用肝素盐水冲洗或注入尿激酶24ku冲洗溶解残留血栓碎屑。结果:均自髂股、股浅、股深静脉取栓成功。随访0.5～3年17例肢体完全或基本恢复正常,有效率85％。结论:髂股静脉血栓形成与静脉行程长、易受压等解剖特点有关。Fogarty导管取出严重型静脉血栓是一种有效安全的方法;应用肝素冲洗或注入尿激酶可有效的清除残余血栓碎屑;松解受压血管可减少术后并发症。     

先天性大血管转位变异二例报告

肾后段左下腔静脉合并右髂静脉闭塞及右位主动脉弓合并头臂动脉分支异常罕见,现将我院经数字减影血管造影(DSA)检查确诊的两例报告如下:例1:男、37岁,3月前因右外踝外伤,继发感染,右下肢疼痛,肿胀,跛行,转我院诊断为右髂静脉炎.经右下肢深静脉造影及右股静脉插管DSA:发现右髂总静脉闭塞,右下肢静脉血经腹壁浅静脉或右与左髂内静脉属支间吻合支入左髂内静脉注入下腔静脉形成侧付循环.经左股静脉插管DSA:肾后段下腔静脉沿脊柱左侧上行,当汇集左肾静脉后,于第二腰椎水平处斜形越过脊柱前方,收纳右肾静脉后,沿脊柱     

下肢深静脉血栓的超声诊断价值及相关诊断方法的应用

目的 研究下肢深静脉血栓的超声诊断价值及相关诊断方法的应用。方法 选取2018年5月~2019年5月在我院诊治的132例下肢深静脉血栓患者临床资料,患者均采用常规超声和多普勒超声检查,比较两种诊断方法下肢静脉血栓的检出率、不同节段下肢静脉血栓灵敏度。结果 彩色多普勒超声检查下肢深静脉血栓检出率为96.21%,高于常规超声检查的80.30%,差异有统计学意义（P＜0.05）;彩色多普勒超声检查不同节段下肢深静脉血栓（股静脉、髂总静脉、腘静脉、胫后静脉、胫前静脉）灵敏性、特异性查比较,差异有统计学意义（P＜0.05）;彩色多普勒超声对股静脉（96.66）、腘静脉（92.59）的灵敏性较高,对髂总静脉、胫后静脉、胫前静脉的灵敏性较低。结论 下肢深静脉血栓采用彩色多普勒超声检出率高,且对出不同节段深静脉血栓灵敏性存在差异,无创伤,具有良好的重复性,有一定的的诊断价值。     

大鼠后肢深静脉血栓模型的制备与研究

目的 用SD大鼠建立后肢深静脉血栓（DVT）动物模型，利用此模型进行形态学研究。方法 手术结扎下腔静脉和髂总静脉法建立SD大鼠DVT模型，通过肉眼观察和组织学研究DVT模型的股静脉血栓形成情况。结果 在手术后6h、12h、24h、2d、4d、8d六个时间点，实验组DVT发生率显著高于对照组；实验组动物股静脉内皮细胞受到损害，白细胞粘附并浸润股静脉壁。结论 利用结扎下腔静脉和髂总静脉法可建立SD大鼠DVT模型，白细胞在DVT形成中起重要作用。     

Catheter-Directed Thrombolysis with Conventional Aspiration Thrombectomy for Lower Extremity Deep Vein Thrombosis

Purpose

The purpose of this study is to evaluate treatment outcomes in patients with symptomatic deep vein thrombosis (DVT) who had undergone a catheter-directed thrombolysis with conventional aspiration thrombectomy for the treatment of lower extremity deep vein thrombosis.

Materials and Methods

The authors retrospectively reviewed the records of 74 patients (mean age 61 ± 15) that underwent a catheter-directed thrombolysis with conventional aspiration thrombectomy. A retrieval inferior vena cava (IVC) filter was placed to protect against a pulmonary embolism in 60 patients (81%). Stenting and balloon angioplasty were performed in 37 patients (50%) under the left common iliac vein compression.

Results

Sixty-seven patients (91%) showed a clinical improvement within 48 hours, but seven patients (9%) showed no improvement. Multi detector computerized tomographic venography (MDCT venography) at discharge showed no thrombus in 15 patients (20%) and partial thrombus in 52 (70%). Twenty-eight patients (38%) developed post-thrombotic syndrome at 3.0 ± 4.2 months postoperatively. Six patients (8%) were admitted due to DVT recurrence at a mean of 5.6 ± 7.4 months postoperatively. Sixty-nine patients underwent follow up MDCT venography at 5.7 ± 5.6 months. fifty (72%) of these showed no thrombus, 15 (22%) partial thrombus, and 4 (6%) showed obstruction. Twentyeight of 61 (46%) were asymptomatic, twentyeight (46%) had moderate improvement, and four (6%) were mildly improved by a telephone interview (81%) at 22.8 ± 10.7 months postoperatively.

Conclusion

Catheter-directed thrombolysis with conventional aspiration thrombectomy is an effective treatment for lower extremity deep vein thrombosis and produces satisfactory clinical results.     

腔静脉滤器置入联合胫后静脉置管溶栓治疗急性下肢深静脉血栓形成

目的：探讨腔静脉滤器置入联合胫后静脉途径置管直接溶栓治疗急性下肢深静脉血栓形成的临床应用价值。方法：18例急性下肢深静脉血栓形成患者,先行患肢血管造影明确诊断后,在下腔静脉滤器置入的基础上采用胫后静脉置管微泵持续推注尿激酶直接溶栓治疗,对其中髂静脉狭窄5例和闭塞1例患者在拔除溶栓导管后实施髂静脉球囊扩张成形术。结果：18例患者置管溶栓治疗后症状均得到明显改善,1例术前合并肺动脉栓塞者症状消失。溶栓后的健、患侧大腿周径差及小腿周径差比治疗前明显减小,差异均有统计学意义（P〈0．001）。治疗期间,无一例围手术期死亡,无肺动脉栓塞发生,无置管处渗血或血肿形成、神经损伤等置管相关并发症发生。术后17例获随访,随访时间1～12个月,平均5个月。15例肢体肿胀基本消退、肌张力减低、恢复正常劳动力;2例活动后肢体出现轻微肿胀伴沉重感,能进行正常家务劳动;17例均未出现患肢浅静脉曲张及静脉营养性障碍。结论：腔静脉滤器置入联合胫后静脉置管直接溶栓治疗急性下肢深静脉血栓形成具有疗效好、创伤小、安全性高、适应证宽,便于护理等优点,是一种安全、有效的治疗方法。     

产妇深静脉血栓形成16例分析

本文报告16例产妇深静脉血栓形成。13个急性病例中12例用尿激酶治愈,1例截肢。3个慢性病例采用保守治疗等待栓塞静脉再通。由于在妊娠晚期,尤其是在分娩时下腔静脉和髂静脉受膨大子宫压迫导致下肢静脉郁血,加之分娩时血管内凝血活性又达高峰,所以产妇可以发生深静脉血栓形成。如果在分娩时伴有休克、缺氧或手术刺激等导致静脉内膜损伤则深静脉血栓形成发生的危险性更大。尿激酶溶栓疗法治疗急性深静脉血栓形成有效。     

Diagnosis and treatment of inferior vena cava thrombosis

A total of 572 patients with acute thrombosis in deep veins of the inferior vena cava system were treated in the Department of Vascular Surgery. X-ray contrast retrograde iliocavography (XICG) revealed 96.5 % cases of iliocaval segment thrombosis. Signs of thromboembolism in pulmonary artery branches (TELA) were detected by angiopulmonography (APG) in 92.3% cases. Thrombectomy was undertaken in 62 (39.7%) of the patients, venous clipping or placation without thrombectomy were performed in 94 (60.3%) ones. All operated patients experienced regress of clinical symptoms of deep vein thrombosis in the absence of TELA and were discharged in good clinical condition. It is concluded that surgical techniques for the prevention of TELA should be chosen on an individual basis taking account of thrombus character and location detected by central duplex scanning, XICG and APG.     

Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.     

A case of an additional right external iliac vein surrounding the right external iliac artery and lacking the right common iliac vein

A case of an additional right external iliac vein lacking a right common iliac vein was found in an 84-year-old female cadaver during a dissection course at Aichi Medical University in 2014. The findings are reported and discussed from the embryological and clinical viewpoints. The right and left iliac venous systems were macroscopically observed with attention to the homonymous arteries and the inferior vena cava. In this cadaver, a preaortic external iliac vein originated from a right external iliac vein and drained directly into the inferior vena cava. The preaortic and right external iliac veins surrounded the right external iliac artery. In addition, the right internal iliac vein drained into the left common iliac vein, and the right obturator vein drained into the right external iliac vein. Our findings suggested that normal external iliac veins developed from the ventral limb of the iliac venous system in this case. Our case has clinical importance for surgical complications such as hemorrhages in pelvic operations, phlebography, and especially central venous cauterization of the right femoral vein.     

间歇气囊压迫在治疗急性下肢深静脉血栓中的疗效观察

目的探讨下腔静脉滤器植入后间歇气囊压迫治疗急性下肢深静脉血栓的可行性和疗效。方法选择60例下肢深静脉血栓经下腔静脉滤器植入的患者。按随机原则分为实验组和对照组,实验组在对照组基础上加间歇气囊压迫治疗。观察两组患者治疗前后患肢周径,血栓复发率。结果经治疗后实验组患者大小腿周径缩小,与治疗前和对照组比较差异有显著性意义（P〈0．01）。实验组患者血流变指标,低于治疗前和对照组（P〈0．05）。在随访6～12个月,患者无血栓后遗症,下肢肿胀感消失。结论下腔静脉滤器植入后联合间歇气囊压迫治疗对于急性下肢深脉血栓治疗效果显著。