股青肿二例治疗体会

近 3年我院收治股青肿 2例 ,采用综合治疗 ,疗效满意。报告如下。临床资料男性 1例 ,女性 1例。年龄分别为49、47岁。患本病前有卧床病史 ,1例右胫骨下段骨折 ,行手法复位石膏托固定 ,1例肝癌行肝不规则切除术后 1个月 ,均为左下肢。发病至就诊时间分别为 32ｈ、37ｈ。临床表现有患肢剧烈胀痛 ,整个下肢高度肿胀 ,术前两侧大腿周径差别为 10ｃｍ、9ｃｍ ,皮肤紧张 ,发亮 ,大腿中下 1/3以下紫绀色 ,小腿有水泡 ,皮温明显降低 ,患肢股动脉搏动弱 ,、足背及胫后动脉搏动消失 ,1例体温 37.5℃ ,1例体温 39℃ ,并有休克 ,ＢＰ 80 /45ｍｍＨｇ。…     

溶栓导管接触性溶栓治疗下肢股青肿体会

对9例股青肿患者行患肢口静脉穿刺,在DSA下将溶栓导管插入到血栓近心端,经导管首次推注尿激酶20万U后,微量泵持续泵入尿激酶20～30万U／8h,同时经血管鞘持续泵入肝素钠7500～100001U／24h。以下肢皮色和皮温变化、消肿情况及深静脉造影评价溶栓效果。经溶栓导管治疗后9例患者皮色皮温改善,无一例发生下肢静脉坏疽,7例完全消肿,完全消肿率77,78％,患肢总消肿率8621％。下肢深静脉血栓部分或完全消融,6例完全溶解,完全溶栓率66．67％,总溶栓率96．97％。未发生严重并发症。溶栓导管接触性溶栓治疗下肢股青肿临床效果满意,是一种安全、有效的临床治疗方法。     

介入联合手术治疗Cockett综合征合并股青肿

目的探讨采用手术联合介入方法治疗Cockett综合征合并股青肿的疗效。方法对2005—2010年采取介入联合手术处理的5例Cockett综合征合并股青肿患者的临床资料进行回顾性分析。结果 5例患者均有典型股青肿表现,其足背动脉、胫后动脉搏动均消失,术前多普勒均提示左下肢深静脉无血流,术中DSA均提示左髂静脉受压狭窄,证实为Cockett综合征。5例患者均行下腔静脉滤器植入,股静脉切开取栓,左髂静脉球囊扩张,其中1例行支架植入,术后均给予抗凝、溶栓治疗。术后患者均恢复满意,足背动脉搏动恢复,下肢肿胀缓解,随访3个月至5年未见血栓复发及其他并发症。结论采用介入联合手术治疗Cockett综合征合并股青肿疗效确切,效果好。     

经皮机械血栓清除术联合导管接触性溶栓术治疗急性股青肿的疗效

目的 探讨经皮机械血栓清除术（PMT）联合导管接触性溶栓术（CDT）治疗急性股青肿的疗效和安全性。方法 收集2018年1月至2021年4月重庆医科大学附属巴南医院收治的14例青肿患者的临床资料,均进行PMT联合CDT治疗,记录患者的住院时间、尿激酶用量、溶栓时间、术中失血量、并发症发生情况,分析患者的机械吸栓术成功率、血栓清除率、消肿率。结果 14例患者均成功行PMT并取得Ⅱ级及以上的血栓清除。平均溶栓时间（1.93±0.59）d,尿激酶用量（95.00±26.66）万单位,溶栓后7例患者合并髂静脉压迫综合征,其中6例置入支架。溶栓后,14例患者下肢肿胀症状明显好转,均取得Ⅲ级血栓清除,平均住院时间（6.00±0.93）d,大腿消肿率（83.09±2.53）%,小腿消肿率（81.47±3.03）%。围手术期除3例穿刺点出血外无其他并发症发生。平均随访（22.86±10.00）个月,2例患者死亡,1例患者血栓复发,1例患者发生轻度深静脉血栓后综合征（PTS）,彩色多普勒超声提示12例患者髂股静脉均通畅,但3例患者伴轻度股静脉瓣膜反流。结论 PMT联合CDT治疗急性股青肿疗效确切且安全性高...     

Cockett综合征合并股青肿的综合治疗分析：附7例报告

目的：探讨应用下腔静脉滤器置入、手术取栓、静脉溶栓综合治疗Cockett综合征合并股青肿（PCD）的途径及疗效。方法：对10年间收治的Cockett综合征合并PCD的7例患者的临床资料进行回顾性分析。结果：7例均有典型PCD表现, 其足背动脉、胫后动脉搏动均消失；均经多普勒检查证为Cockett综合征合并PCD；均行手术治疗。3例行腔静脉滤器植入术, 3例行球囊导管阻绝术, 1例患者行PALMA术, 7例均行术中取栓和术后溶栓治疗。7例术后患肢足背动脉搏动均恢复, 疼痛消失, 消肿, 未出现手术并发症。经6个月至3年随访, 未见血栓复发及其他并发症发生。结论：综合介入、手术、溶栓治疗Cockett综合征合并PCD不仅成功率高, 近期疗效好, 而且安全可靠。     

重症下肢深静脉血栓形成治疗的临床研究

目的 探讨综合应用下腔静脉滤器置入、手术取栓、同时处理Cockett综合征、术后抗凝及溶栓等方法 治疗重症下肢深静脉血栓(股青肿)的疗效.方法 回顾近10余年9例重症下肢深静脉血栓患者的临床资料.9例中8例行下腔静脉滤器置入、手术取栓、术后抗凝及溶栓,8例中有7例为左下肢深静脉血栓患者.均发现合并不同程度的Cockett综合征,其中2例同时处理Cockett综合征;9例中1例(左下肢深静脉血栓患者)行下肢静脉溶栓术.结果 所有患者均无肺栓塞发生,经手术的8例患者除1例(左下肢深静脉血栓患者)术后出现湿性坏疽,被迫截肢外,其余7例均取得较为满意的疗效,挽救了患肢.1例行下肢静脉溶栓的患者死亡.1个月后复查彩超,没有同时处理Cockett综合征的5例中有2例左下肢血栓患者复发血栓,但均未再次发展为股青肿.7例随访1.5～10年,均未发生严重并发症.结论 综合应用下腔静脉滤器置人、手术取栓、同时处理Cockett综合征、术后抗凝及溶栓等方法 是治疗重症下肢深静脉血栓(股青肿)的有效方法 ,Cockett综合征是左下肢DVT取栓术后复发的重要原因.     

动脉闭塞性疾病的外科治疗——利用股深动脉重建严重缺血下肢血循环

动脉粥样硬化是导致下肢动脉管腔狭窄和闭塞最常见的病变，严重威胁肢体的生存。当髂股动脉或股浅动脉广泛性闭塞时，股深动脉由于其独特的解剖条件和生理功能，为重建下肢血液循环起到了重要作用。本文就其临床意义和各种手术方法加以讨论。     

肺栓塞17例诊断体会

我院自2002年1月∽2003年4月共收治肺栓塞(pulmonary embolism，PE)17例，现将诊断体会报告如下。     

深静脉血栓形成（附4例报告）

深静脉血栓形成（附４例报告）朴庆云我院于１９８２～１９９３年收治４例髂股静脉血栓形成，现报告如下：１临床资料例１，孙△△，男，１７岁，因左股骨上端急性骨髓炎伴左髓关节化脓性关节炎，于１９８２年７月１日入院。住院期间，左下肢发生水肿，进展迅速，周径显著...     

Trends in management of phlegmasia cerulea dolens

Phlegmasia cerulea dolens (PCD) is a fulminant condition of acute massive venous thrombosis that may result in major amputation or death unless treated in an early phase. Guidelines for treatment are still not clearly documented. As a consequence, physicians might have limited knowledge of this potential life-threatening condition and its clinical course. Therefore, the purpose of this review was to analyze and summarize clinical manifestations and proposed diagnostic approach, factors that affect the outcome of PCD, and the evolution of management and therapeutic options. Underlying malignancy, pulmonary embolism, and PCD severity are the vital factors that predict the outcome of PCD. In the last decades, treatment options have remained largely unchanged. Published evidence shows that advances in minimally invasive techniques have not yet resulted in outcome improvements compared with traditional surgical thrombectomy. Treatment seems to depend on grading the severity of this condition and experience of the surgeon.     

Pharmacomechanical thrombolysis for phlegmasia cerulea dolens

Phlegmasia cerulea dolens (PCD) is limb-threatening. Traditional treatments are very morbid. We examine the efficacy of percutaneous treatment of PCD. Between May 2005 and September 2008, we treated 21 limbs in 20 patients with lower extremity PCD who were candidates for thrombolysis. Diagnosis was by clinical examination and duplex ultrasound. Catheter access to the deep venous system was obtained through a popliteal vein. Therapy used pulse spray thrombolysis with tissue plasminogen activator (tPA). Infusion catheters and adjunctive percutaneous techniques were used as indicated. Postoperatively, patients were treated with systemic anticoagulation, compression hose, and interval follow-up. Limbs were graded according to the CEAP classification. Twenty patients (13 male) were treated with a mean age of 55.8 years. Nine patients had hypercoagulable states, four May Thurner syndrome, three a history of cancer, one postcolon resection, one acute myocardial infarction, and one postfemoral vein puncture. All patients had resolution of PCD without the need for open surgery. The initial tPA dose was 19.5 mg with pulse spray thrombolysis. Infusion catheters were required in 18 patients and used for 16.1 hours (range, 8 to 36 hours) until complete thrombolysis. Venous angioplasty was necessary in 14 patients with nine of these requiring venous stents. One patient required above-knee amputation despite successful treatment of her PCD. Mean follow-up was 10.7 months (range, 1 to 39 months). All patients demonstrated no or minimal residual thrombus and intact valvular function and a mean clinical CEAP score of 2.4. Percutaneous treatment of PCD produced excellent results with minimal morbidity.     

Circulation studies in experimental phlegmasia cerulea dolens

A model of phlegmasia cerulea dolens in the canine hind limb was used to study the effects of heparin, sympathectomy, and venous thrombectomy plus heparin on limb hemodynamics. Only thrombectomy plus heparin restored nutrient blood flow and was associated with clinical recovery of the limb. This experimental model of phlegmasia appears to be an excellent tool for testing additional modalities of therapy for this serious disease.     

Simultaneous arterial and venous ultrasound-assisted thrombolysis for phlegmasia cerulea dolens

Phlegmasia cerulea dolens is a rare condition in which an extensive deep venous thrombus can partially or completely occlude venous outflow from the affected extremity. Clinical presentation is typically characterized by extremity edema, cyanosis, and pain. This condition is associated with a high rate of extremity amputation and mortality. Although numerous therapies have been described, there is no generalized treatment consensus and less invasive forms of therapy continue to evolve. We report a case of phlegmasia cerulea dolens in a patient who presented with concomitant arterial and venous thrombosis of the affected extremity. The patient's condition was successfully treated using combined ultrasound-assisted intra-arterial and intravenous catheter-directed thrombolysis.     

Spontaneous psoas abscess: presenting with phlegmasia cerulea dolens

Phlegmasia cerulea dolens (PCD) is a limb-threatening venous disorder involving massive proximal venous thrombosis. The clinical manifestations are of oedema, cyanosis and pain of lower extremity. Patients presenting with PCD have an underlying pathological condition that predisposes to the thrombotic process. We report a diabetic patient who presented with PCD and septicaemia due to a spontaneous psoas abscess. Anticoagulation with heparin and treatment of the underlying psoas abscess led to complete resolution of symptoms. An understanding of the underlying pathological process responsible is vital to early recognition and successful outcome in this rare limb- and life-threatening venous disorder.