手术后下肢深静脉血栓形成的诊治

目的探讨下肢深静脉血栓形成的诊断和治疗方法。方法回顾分析下肢深静脉血栓形成106例的临床资料。结果经抗凝、溶栓等治疗后62例治愈,发展为深静脉血栓形成后综合征(PTS)39例;并发肺栓塞(PE)3例,死亡1例;脑出血2例,死亡1例。结论彩色多普勒是诊断手术后下肢深静脉血栓形成最常用的方法,一经确诊,应尽早进行抗凝、溶栓治疗,防止DVT蔓延和PE的发生,同时可以减少PTS的发生率。     

急性下肢深静脉血栓形成后肺栓塞严重程度的危险因素分析

目的 探讨急性下肢深静脉血栓形成患者肺栓塞严重程度的危险因素.方法 本研究为前瞻性研究.2010年7月至2012年7月收集首都医科大学附属北京世纪坛医院血管外科诊断的急性下肢深静脉血栓形成的患者资料,其中符合纳入、排除标准的208例患者纳入本研究.其中男性101例,女性107例,平均年龄(59±16)岁.利用肺动脉CT血管造影、肺动脉磁共振血管造影或肺动脉数字减影血管造影筛查肺栓塞,并评估其肺栓塞程度.采用x2检验和Logistic回归对深静脉血栓形成患者发生肺栓塞程度的危险因素进行单因素和多因素分析.结果 208例下肢深静脉血栓形成患者中70例发生肺栓塞,总体发生率为33.7％.单因素分析结果显示,下肢深静脉血栓范围(x2=17.286,P=0.004)、下肢深静脉血栓部位(x2=15 602,P=0.008)对肺栓塞的严重程度有影响.年龄(x2=7.099,P=0.260)、性别(x2=7.014,P=0.067)、明显血栓危险因素(x2=3.335,P=0.345)对肺栓塞的严重程度无影响.多因素有序Logistic回归分析显示肺栓塞的程度随着下肢深静脉血栓范围的扩大和部位的增加而加重,髂股静脉血栓(OR =6.172,95％ CI:1.590 ～ 23.975,P=0.009)、双下肢深静脉血栓(OR=7.140,95％ CI:2.406 ～ 24.730,P=0.001)是肺栓塞严重程度的独立危险因素.结论 髂股静脉血栓形成、双侧下肢深静脉血栓形成是发生严重肺栓塞的独立危险因素,对这些高危患者应更加注重肺栓塞的防治.     

下肢手术后有症状的下肢深静脉血栓形成

目的：探讨下肢手术后有症状的下肢深静脉血栓形成的临床特点,早期诊断方法和预防措施,方法：对5例支手术后发生有症状的下肢深静脉血栓形成患者的临床表现和彩色多普勒结果进行分析。结果：下肢手术后小腿出现疼痛是下肢深静脉血栓形成最早出现并具有很高诊断价值的临床特点,手术后肢体加压包扎是一促进下肢深静脉血栓形成的可能因素。结论：下肢手术后出现小腿后侧疼痛时应考虑下肢深静脉血栓形成的可能,彩色多普勒检查可明确诊断,对高危患者围手术期应采取综合预防措施。     

九味洗药治疗深静脉血栓形成临床体会

下肢深静脉血栓形成是外科多发病,目前对急性DVT的治疗效果还不够满意,自拟无味洗药治疗深静脉血栓48例,运用中药外治理论,针对下肢深静脉血栓形成的中医病因病机分析,结合下肢深静脉血栓形成治疗效果评价,疗效显著,无肺栓塞等不良事件发生.     

孕产妇下肢深静脉血栓形成的诊治策略分析

目的总结孕产妇下肢深静脉血栓形成的诊治策略。方法回顾性分析山东第一医科大学第一附属医院血管外科2016年1月至2019年12月收治的37例孕产妇合并下肢深静脉血栓形成患者的临床资料,总结患者下肢肿胀症状改善情况及预后。结果所有患者均应用抗凝及压力治疗,11例产妇下肢肿胀症状均明显改善,26例孕妇中4例终止妊娠,22例正常分娩,未出现死亡病例,无消化道出血等大出血发生,未发现明显肺栓塞表现,治疗效果满意。结论孕产妇合并下肢深静脉血栓形成的诊治与普通人群有一定差异,应采取个体化治疗,采取抗凝治疗为主的治疗方案。     

预防手术后静脉血栓形成的现况

深静脉血栓形成是手术病人术后一种常见的并发症。据1980年Salzman收集的15篇文献,术后临床诊断为深静脉血栓形成的发病率为1～15％不等。少数病例可发生致命的肺栓塞,Salzman复习10篇文献,8120例术后病人中经临床证实发生肺栓塞者达149例,而尸检发现的肺栓塞更多。10年前开始应用碘标记纤维蛋白元扫描技术这种检查下肢静脉血栓形成最灵敏的方法,发现了不少无症状的深静脉血栓形成,使其发病数大增,内科或外科卧床病     

腰间盘术后下肢深静脉血栓形成的防治

本文报告6例腰椎间盘术后并发下肢深静脉血栓形成病人,占同期897例腰间盘术后病人的0.7％。作者就该并发症的发病原因、诊断、预防及治疗等方面的问题进行了探讨。认为手术时间过长、出血过多、大量输血及术后长时间应用止血药等因素可诱发下肢深静脉血栓形成。该病处理的基本原则是早期诊断和及时治疗,保守治疗72小时无效,应及时采取手术取栓治疗;手术采用Fogarty导管和驱血带祛除血栓,以恢复下肢深静脉血流,结果疗效满意。     

老年人急性下肢深静脉血栓形成的治疗体会

目的 总结老年人急性下肢深静脉血栓形成的病因和诊治方法。方法 回顾分析37例老年人急性下肢深静脉血栓形成患者的临床资料。结果 有相关DVT危险因素共21例，占56．8％(21／37)，骨折史9例，以骨折后并发DVT最多。手术治疗3例，有效2例，好转1例；非手术治疗34例，有效30例，好转3例，死亡1例。结论 对老年人急性下肢深静脉血栓形成应积极预防、早期发现、及时治疗，以预防肺栓塞发生。     

腰椎间盘突出症术后下肢深静脉血栓形成

目的：了解腰椎间盘突出症术后下肢深静脉血栓形成的发生率，方法：总结1200例腰间盘突出症，分析下肢深静脉血栓形成的发病情况。结果：1200例腰椎间盘手术后发生下肢深静脉血栓形成21例，发生率为1．7％，未发生症状性肺栓塞，结论：承着老年病人腰椎间盘手术的增多，下肢深静脉栓塞的发生率将增加，应引起骨科医生的高度重视，针对存在高危因素的患者酌情进行适当的预防性治疗。     

42例合并免疫病的深静脉血栓的特点及诊治体会

目的探讨伴有自身免疫性疾病的深静脉血栓形成的特点及诊断与治疗。方法回顾性分析42例合并免疫性疾病的深静脉血栓形成的特点及诊断、治疗方法。结果42例患者中有15例合并肺栓塞,占35.7%,其中抗磷脂抗体阳性者7例。全部病例经溶栓、抗凝等治疗后都康复出院,随访期间血沉及C-反应蛋白仍高于正常者16例,其中,复发下肢静脉血栓2例,动脉血栓1例,肠系膜上静脉血栓形成1例。结论自身免疫性疾病并发深静脉血栓形成起病隐匿,易被忽视,应早期诊断。抗磷脂抗体综合征是肺栓塞的高危因素,故抗凝周期应延长;并重视原发疾病的治疗。     

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??Pay attention to the prevention and treatment of deep evenous thrombosis of lower limbs and pulmonary thromboembolism in patients after abdominal surgery JIANG Hong-chi??ZHU Hua-qiang. Department of General Surgery,the First Affiliated Hospital of Harbin Medical University, Harbin 150001,China
Corresponding author ??ZHU Hua-qiang,E-mail: zhuhuaqiang @ yahoo. cn
Abstract Pulmonary thromboembolism is the most serious complication of deep venous thrombosis of lower limbs, which is an insidious threaten for some patients. Deep venous thrombosis of lower limbs and pulmonary thromboembolism are not uncommon in patients after abdominal surgery. We should pay more attention to preventing deep venous thrombosis and pulmonary thromboembolism. Furthermore, clinicians should be familiar with the clinical manifestations, and comprehensively analyze the medical history and risk factors to make a timely diagnosis. Misdiagnosis and missed diagnosis should be minimized. Once the diagnosis is confirmed, the concept of fast track surgery should be adopted and various effective measures and reasonable treatment should be applied to achieve faster and better recovery.     

Frequency and timing of clinical venous thromboembolism after major joint surgery

Over a 13-year period we studied all patients who underwent major hip and knee surgery and were diagnosed with objectively confirmed symptomatic venous thromboembolism, either deep venous thrombosis or non-fatal pulmonary embolism, within six months after surgery. Low-molecular-weight heparin had been given while the patients were in hospital. There were 5607 patients. The cumulative incidence of symptomatic venous thromboembolism was 2.7% (150 of 5607), of which 1.1% had developed pulmonary embolism, 1.5% had deep venous thrombosis and 0.6% had both. Patients presented with deep venous thrombosis at a median of 24 days and pulmonary embolism at 17 days after surgery for hip fracture. After total hip replacement, deep venous thrombosis and pulmonary embolism occurred at a median of 21 and 34 days respectively. After total knee replacement, the median time to the presentation of deep venous thrombosis and pulmonary embolism was 20 and 12 days respectively. The cumulative risk of venous thromboembolism lasted for up to three months after hip surgery and for one month after total knee replacement. Venous thromboembolism was diagnosed after discharge from hospital in 70% of patients who developed this complication. Despite hospital-based thromboprophylaxis, most cases of clinical venous thromboembolism occur after discharge and at different times according to the operation performed.     

Hemorheology and blood thrombotic potential in pulmonary thromboembolism

Examination of 138 patients with acute venous thrombosis of the lower limbs, which was complicated by thromboembolism of the pulmonary artery in 49 of them, showed the rheologic status to be disturbed to a greater extent in patients with pulmonary embolism than in those with acute venous thrombosis. An interrelationship between the rheologic properties and the coagulation system of the blood in various conditions of the hemostasis system was revealed. It is pointed out that pathogenetically grounded correction of the disorders of the blood coagulation and rheologic systems is necessary in choosing the method for treatment and prevention of acute venous thrombosis and pulmonary embolism.     

Relationship between deep vein thrombosis and pulmonary embolism following THA and TKA

Patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are at risk for venous thromboembolisms, including deep vein thrombosis and pulmonary embolism. Most deep vein thromboses are asymptomatic, but they can lead to long-term morbidity to the same extent as symptomatic events. The risk of complications of venous thromboembolisms depends on the location of thrombi; potential long-term complications include recurrent venous thromboembolism, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Risk of recurrence persists for several years after the initial event. Approximately 20% of recurrent events are pulmonary embolisms, and approximately half of those are fatal. The causal relationship between deep vein thrombosis and pulmonary embolism remains controversial. Some consider them distinct clinical entities, while others have found asymptomatic distal deep vein thrombosis to be associated with elevated risk of developing pulmonary embolism. Unique coagulation factors may be associated with orthopedic surgery patients that differentiate them from patients undergoing other types of surgery. Symptomatic and asymptomatic deep vein thrombosis can lead to the development of recurrent venous thromboembolism, pulmonary embolism, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension, all of which are associated with reduced quality of life and increased health care expenditures. Thromboprophylaxis is therefore important in patients undergoing THA or TKA. However, traditional anticoagulants are not ideal, particularly for long-term use. Orthopedic surgeons should be aware of the causes and potential sequelae of venous thromboembolism and of the new thromboprophylactic agents that can help prevent it.     

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目的　探讨二维彩色多普勒超声显像 (CDFI)对下肢深静脉血栓形成 (DVT)的诊断价值。方法　1998～ 2 0 0 3年对 97例下肢DVT病人进行CDFI检查 ,了解病肢深静脉的管壁、管径、血栓位置、大小、范围、静脉瓣功能及静脉血流情况。结果　 97例 (98条 )下肢DVT病例中 ,伴有下肢深静脉瓣功能不全者 6例。其中 ,中央型 2 1条 (2 1 4 2 % ) ,周围型 4 6条 (4 6 94 % ) ,全肢型 31条 (31 6 4 % )。病肢左右侧之比为 3 3:1(P <0 0 0 1)。结论　CDFI在下肢DVT方面具有特异性表现 ,可以成为下肢DVT诊断、预后判断和随访的首选方法。     

Postoperative deep vein thrombosis in the lower extremity amputee: A prospective study with Doppler ultrasound.

The incidence of postoperative venous thrombosis and pulmonary embolism was assessed in 87 patients undergoing 96 major lower extremity amputations for ischemia. Prospective surveillance for deep leg vein thrombosis was carried out by Doppler ultrasound in 35 patients. There was no instance of major leg vein thrombosis and only one episode of a small non-fatal pulmonary embolus in a patient suffering trauma to the amputation stump after discharge from the hospital. This study suggests that clinically significant venous thromboembolism following current techniques of lower extremity amputation is not as common as previously reported. Doppler ultrasound is the most suitable technique for surveillance of venous thrombosis in these patients.     

Thromboembolism Following Foot and Ankle Surgery: A Case Series and Literature Review

Venous thromboembolism following major orthopedic procedures of the hip and knee is well documented and patients are therefore routinely prophylaxed following these proximal lower extremity procedures. In contrast, foot and ankle surgery is considered by most health care professionals to be a low-risk procedure for the development of venous thromboembolism. As a result, pharmacologic deep venous thrombosis prophylaxis is rarely administered. This postoperative practice is supported by the literature regarding deep venous thrombosis following foot and ankle surgery. In this article, we review the risk factors and explore the occurrence of thromboembolism after foot and ankle surgery in the literature. We also present our retrospective study of patients who developed venous thromboembolism after forefoot, midfoot, hindfoot, and ankle procedures. Over the course of 1.5 years, 4 of a consecutive series of 1000 patients (0.4%) developed a deep venous thrombolism and 3 of 1000 (0.3%) developed nonfatal pulmonary emboli. In our series, each of our patients who developed venous thromboembolism had at least 2 identifiable risk factors. The incidence of venous thromboembolism following foot and ankle surgery is rare (less than 1%), and the need for routine propylaxis postoperatively is not supported by any high level of evidence studies. LEVEL OF CLINICAL EVIDENCE: 4.     

The importance of forseeing and early diagnosis of thromboembolic disease

The aim of this study is to assess the incidence of thromboembolism in laparoscopic cholecystectomies. 100 unselected patients undergoing laparoscopic procedures performed by the same team were studied. All patients received preoperative prophylaxis with low/molecular weight heparin (LMWH), which was continued until full mobility. Four cases of deep venous thrombosis of lower limbs were clinically identified and confirmed by means of Doppler ultrasound examination. There were no cases of pulmonary embolus. Deep venous thrombosis occurred during the prophylactic administration of LMWH in the fourth postoperative day, consequently intravenous treatment with Heparin and then with oral anticoagulants was required. In each observation the operation took more than one hour. Among the patient-dependent risk factors, we have identified: age above 40 years, obesity, history of deep venous thrombosis, localized preoperative infection, congestive cardiac failure. Although the thromboprophylaxis has been performed within the laparoscopic surgery similar to that recommended in the classical procedures, when a high risk has developed the illness started. We underline the importance of a careful postoperative clinical monitoring in order to prevent the serious accidents that may appear.     

Current status of pulmonary embolism and venous thrombosis prophylaxis

Prophylaxis for venous thromboembolism is an area that has received intense study in certain conditions, but less than adequate coverage in other areas. In considering who needs prophylaxis, patients are categorized into levels of risk. Clinical venous thromboembolism can be correlated to these levels of risk. Methods of prophylaxis include pharmacologic, mechanical, and combinations of these. Each category of surgical and medical patient requires specific types of prophylaxis. In certain orthopedic indications, the length of prophylaxis outlasts the inpatient hospital stay and may be as long as 1 month after discharge. Even with the best prophylaxis today, the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) is decreased by only approximately 70% to 80%. Further developments should allow for greater declines in the rates of venous thromboembolism, with its subsequent short-term consequence of pulmonary embolism and lower extremity morbidity and long-term consequence of the disabling syndrome of chronic venous insufficiency (CVI).     

Venous thromboembolism prophylaxis

Venous thromboembolism is a common and frequent complication of hospitalized patients. Some venous thromboembolisms may be subclinical, while others present as symptomatic deep vein thrombosis and/or pulmonary embolism. Venous thromboembolism and pulmonary embolism contribute significantly to inhospital morbidity and mortality. The risk of venous thromboembolism is aggravated by dispositional and/or expositional risk factors. In patients at intermediate or high risk of venous thromboembolism, additional pharmacological thromboembolism prophylaxis becomes mandatory.