腹腔镜胆道术后下肢深静脉血栓形成的防治

目的探讨腹腔镜胆道术后下肢深静脉血栓形成（DVT）的原因及其治疗。方法回顾性分析我院1999年10月-2007年10月收治的腹腔镜胆道术后发生下肢DVT的45例临床资料。本组采用抗凝、溶栓治疗35例．深静脉插管溶栓治疗8例,手术取栓2例。结果全组病例治疗后症状均有不同程度好转。结论腹腔镜胆道手术病人是术后下肢深静脉血栓形成（DVT）的高危人群,围手术期的积极预防及早发现,早治疗可取得较好疗效。     

经腘静脉插管定向溶栓治疗下肢深静脉血栓形成的临床研究

目的评价腘静脉插管定向溶栓治疗下肢深静脉血栓的疗效。方法 62例下肢深静脉血栓患者,行患肢腘静脉穿刺插管,在可视条件下将导管插入至血栓近心端,经导管首次推注尿激酶20万单位后,持续注射尿激酶10万单位／h溶栓,同时每12 h皮下注射低分子肝素钠400 U。以下肢肿胀消退情况评价疗效,以深静脉造影评价溶栓效果。结果经导管溶栓治疗不仅使深静脉血栓部分或完全消融,而且侧支循环开放较治疗前显著增加。患肢总消肿率(78±22)％,总溶栓率(67± 27)％,其中急性、急慢性和慢性病例溶栓率分别为75％、71％,49％,前两者显著高于后者(P< 0．05)。21例患者血栓完全消融,无严重并发症发生。结论 腘静脉插管定向溶栓治疗下肢深静脉血栓形成能够快速溶解血栓,恢复深静脉血流通畅,患者临床症状改善效果满意,治疗方案安全可靠。     

抗凝溶栓治疗对急性下肢深静脉血栓形成预后的影响

目的 探讨抗凝溶栓治疗对急性下肢深静脉血栓形成的疗效及其对下肢深静脉血栓形成后综合征(PTS)的发生率及严重程度的影响.方法 回顾性选择2003年3月至2008年12月收治的急性下肢深静脉血栓形成(中央型及混合型)患者共111例(113条肢体).分别采用单纯抗凝(41条肢体)、系统溶栓(27条肢体)或导管溶栓(45条肢体)三种不同治疗方法,在随访期末收集下肢肿胀及静脉冉通情况,使用Villaha及VCSS评分表评判PTS的发生率及严重程度.结果 单纯抗凝组、系统溶栓组和导管溶栓组平均随访时间分别为(41±19)、(52±11)和(26±10)个月.三组PTS的发生率分别为58.5%(24/41)、55.6%(15/27)和35.6%(16/45),其中重度PTS的比例分别为20.8%(5/24)、3/15和1/16;导管溶栓组的PTS发生率和重度PTS比例低于其余两组(P＜0.05).三组患者双下肢周径差较治疗前均有明显改善(P＜0.05);导管溶栓组随访时的大腿周径差为(0.5 4±1.0)cm,小腿周径差为(0.7±1.0)cm,低于其余二组(P＜0.05).长期使用抗凝药物及弹力袜的患者,PTS发生率较低.结论 深静脉血栓形成急性期在抗凝基础上采用导管溶栓治疗,可降低PTS的发生率并减轻其严重程度,明显改善肢体肿胀.辅以规律抗凝及弹力袜支持,可进一步改善疗效.

Abstract：

Objective To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS). Method A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies:anticoagulant group (41 limbs) , thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS. Results The average time of follow-up were (41±19) months in anticoagulant group, (52±1) months in thrombolysis group, and (26 ±10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58. 5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS ( P ＜ 0. 05 ). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0. 5 ±1. 0) cm and (0. 7±1. 0) cm, which were more obvious compared to other two groups (P ＜0. 05).Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant Pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS. Conclusions The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheterdirected thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.     

抗凝溶栓治疗对急性下肢深静脉血栓形成预后的影响

Objective To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS). Method A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies:anticoagulant group (41 limbs) , thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS. Results The average time of follow-up were (41±19) months in anticoagulant group, (52±1) months in thrombolysis group, and (26 ±10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58. 5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS ( P ＜ 0. 05 ). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0. 5 ±1. 0) cm and (0. 7±1. 0) cm, which were more obvious compared to other two groups (P ＜0. 05).Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant Pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS. Conclusions The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheterdirected thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.     

抗凝溶栓治疗对急性下肢深静脉血栓形成预后的影响

Objective To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS). Method A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies:anticoagulant group (41 limbs) , thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS. Results The average time of follow-up were (41±19) months in anticoagulant group, (52±1) months in thrombolysis group, and (26 ±10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58. 5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS ( P ＜ 0. 05 ). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0. 5 ±1. 0) cm and (0. 7±1. 0) cm, which were more obvious compared to other two groups (P ＜0. 05).Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant Pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS. Conclusions The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheterdirected thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.     

抗凝溶栓治疗对急性下肢深静脉血栓形成预后的影响

Objective To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS). Method A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies:anticoagulant group (41 limbs) , thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS. Results The average time of follow-up were (41±19) months in anticoagulant group, (52±1) months in thrombolysis group, and (26 ±10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58. 5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS ( P ＜ 0. 05 ). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0. 5 ±1. 0) cm and (0. 7±1. 0) cm, which were more obvious compared to other two groups (P ＜0. 05).Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant Pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS. Conclusions The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheterdirected thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.     

下肢深静脉血栓形成的溶栓抗凝治疗：附139 例报告

目的:探讨下肢深静脉血栓形成(DVT)的溶栓抗凝治疗的有效性和安全性.方法:回顾性分析139例下肢DVT患者的临床资料,其中左下肢106例,右下肢28例,双下肢5例,均通过下肢静脉彩超检查确诊.患者均予以低分子肝素钙4 100 U/12 h皮下注射,根据患者起病时间长短及有无禁忌,57例患者予以尿激酶10万U/12 h溶栓治疗,所有患者均同时给予低分子右旋糖酐250～500 mL/d静脉滴注祛聚治疗.若患肢红肿明显,血象增高,辅以头孢类抗生素治疗.出院后服用华法林继续抗凝治疗至少半年.结果:所有患者肢体肿胀、疼痛症状均缓解出院,其中1例合并晚期肿瘤患者为签字要求出院.1例患者入院时即有肺栓塞症状,由于经济原因未安装下腔静脉滤器,经溶栓及抗凝治疗后好转出院.所有患者治疗过程中未发生明显出血等并发症.121例患者获得随访,随访时间1个月至3年,平均14个月.患者症状均明显缓解,恢复正常生活.结论:低分子肝素钙抗凝,尿激酶溶栓治疗在下肢DVT中的应用是安全有效的.     

无滤器保护导管溶栓治疗早期左下肢深静脉血栓

目的 探讨无滤器保护导管溶栓治疗早期左下肢深静脉血栓的适应证、安全性和疗效.方法 2008年7月至2010年6月采用无滤器保护B超引导置管溶栓治疗早期左下肢深静脉血栓54例.男性25例,女性29例,平均年龄52.8岁.中央型3例,混合型51例.病程≤7 d者45例,8 ～30 d者9例.B超检测为完全性,无漂浮血栓,下腔静脉无血栓.经导管泵入尿激酶30万U/2 h,2次/d;皮下注射低分子肝素4000 U,2次/d;或持续泵入普通肝素18 U· kg-1 ·h-1.结果 技术成功率100％.溶栓疗程6～10d,溶栓前评分10.8±1.0,溶栓后评分4.6±2.1;溶栓率(58±18)％,病程≤7 d与8 ～30 d患者相比差异无统计学意义(t=1.02,P=0.34).治疗14 d后痊愈20.4％(11/54),显著好转64.8％ (35/54),好转14.8％ (8/54),总有效率100％.无症状性肺栓塞发生,溶栓前血氧饱和度(91.0±2.6)％,溶栓期间为(90.8±2.4)％,差异无统计学意义(t=2.03,P=0.05).无血尿及脑出血等并发症,导管感染率7.4％( 4/54),穿刺部位有少量出血20.4％(11/54).随访6 ～21个月,随访率66.7％ (36/54);31例患者下肢肿胀完全消失或活动后轻度肿胀,2例患者活动后肿胀较明显,多普勒超声提示股静脉瓣膜功能不全,3例复发.结论 对于完全性、无漂浮血栓、下腔静脉无血栓的早期左下肢深静脉血栓,无滤器保护导管溶栓安全有效.     

经皮机械性血栓清除术治疗下肢深静脉血栓形成的研究进展

静脉血栓栓塞症发病率逐渐增加,即使是在标准抗凝治疗下,仍然有70%以上的患者会发生血栓形成后综合征(PTS),这将严重降低患者生活质量,增加经济负担。因此,快速去除血栓,恢复静脉通路,减少PTS的发生成为近年来临床关注的重点。目前的治疗方法有系统溶栓、导管接触性溶栓(CDT)、手术取栓、血栓抽吸、经皮机械取栓(PMT)等,其中PMT可通过不同物理方法快速清除血栓,减少溶栓药物的使用,虽然目前尚无高质量证据证明其相对于其他方式有更好的安全性及有效性,但PMT为临床医师提供了更多的选择,从而实现个体化医疗,获得最佳的临床效果。本文旨在对目前常见的PMT在原理、特点及局限性等方面进行综述。     

腹部肿瘤根治术后药物预防深静脉血栓

目的 总结腹部肿瘤规范化切除及淋巴结清扫术后深静脉血栓(DVT)预防的治疗经验及效果,探讨术后预防血栓的规范化治疗措施.方法 回顾分析2007年1月至2010年4月间548例接受腹部肿瘤规范化切除及淋巴结清扫病例术后应用低分子肝素、低分子右旋糖酐及丹参注射液防治血栓的临床资料,并按时间及用药方案将患者分为3组:第1组为2007年1月至2008年3月各类手术163例,术后当日起应用低分子右旋糖酐500 ml及丹参注射液0.2 g,持续7 d;第2组为2008年4月至2009年3月各类手术149例,术后当日起应用低分子右旋糖酐500 ml及丹参注射液0.2 g,低分子肝素40 mg,持续7 d;第3组为2009年4月至2010年4月各类手术236例,术后当日起应用低分子右旋糖酐500 ml,丹参注射液0.2 g,持续7 d,第3日起加用低分子肝素40 mg,持续7 d.比较分析三组治疗效果及伴随症状.结果 第1组术后64例(39.3%)D-二聚体检测呈阳性,15例(9.2%)下肢血管多普勒超声检查DVT呈阳性;第2组分别为38例(25.5%)和3例(2.0%);第3组分别为62例(26.3%)和6例(2.5%).总体看来,应用低分子肝素预防性抗凝治疗的第2、3组血栓发生率明显低于不应用低分子肝素的第1组,均应用低分子肝素而用药时间不同的第2、3组间血栓发生率无明显差异.通过临床观察发现,过早应用低分子肝素会导致相应伴随症状的出现.结论 术后当日起应用低分子右旋糖酐及丹参注射液静脉滴注,术后第3大起加用低分子肝素皮下注射对于预防腹部肿瘤根治术后DVT发生的效果较佳.

Abstract：

Objective To summarize the prevention and treatment experience of deep vein thrombosis in patients with abdominal tumors after standardized resection and lymph node dissection, and to investigate a standard therapeutic measure of thrombosis prevention in these patients. Methods The clinical data of 548 patients who received radical operation and standardized lymph node dissection for abdominal tumors from January 2007 to April 2010 were analyzed retrospectively. According to different therapeutic scheme and time, the patients were divided into three groups: Group 1 included 163 cases from January 2007 to March 2008 were treated with compound Danshen injection 0. 2 g and low molecular weight dextran 500 ml on the same day of surgery for 7 days; Group 2 included 149 cases from April 2008 to March 2009 were treated with the same regimen as that in Group 1 plus low molecular heparin 40 mg on the same day of surgery for 7 days; Group 3 included 236 eases from April 2009 to April 2010 were treated with the same regimen as that in Group 1 plus low molecular heparin on the third day of surgery for 7 days. The treatment effects and the complications in the three groups were analyzed and compared. Results Sixty-four (39. 3% ) cases were D-Dimer positive and 15 (9. 2% ) cases were DVT positive under color Doppler ultrasound examination in Group 1; and those were 38 (25.5%) and 3 (2. 0% ) in Group 2; and 62 (26. 3% ) and 6(2. 5% ) in Group 3. Overall observation, the incidences of thrombosis in Group 2 and 3 were obviously lower than that of Group 1, but there was no significant difference between Group 2 and 3.Earlier use of low molecular heparin would lead to some complications. Conclusions It brings better effects in thrombosis prevention by using compound Danshen injection and low molecular weight dextran on the day of surgery, with low molecular heparin on the third day of surgery.     

髋部骨折患者术前静脉血栓栓塞症的预防与治疗

目的 分析髋部骨折患者深静脉血栓形成(DVT)的影响因素,探讨髋部骨折患者术前静脉血栓栓塞症的预防与治疗.方法 选取2008年6月至2010年6月间收治的531例髋部单发骨折患者,男242例,女289例;平均年龄59.2岁(28～93岁).股骨颈骨折336例,股骨转子间骨折183例,股骨转子下骨折12例.分析不同骨折类型、D-二聚体浓度、性别、年龄及术前制动时间与DVT发生率的关系.对于出现DVT的患者,给予放置下腔静脉滤器同时行骨折内固定术. 结果所有531例髋部骨折患者中,股骨颈骨折患者中21例发生DVT,股骨转子间骨折患者中34例发生DVT,股骨转子下骨折患者中无一例发生DVT.55例患者DVT均发生于术前,发生率为10.4%(55/531).髋部骨折患者年龄、性别对DVT的发生率无影响,差异无统计学意义(P值分别为0.347、0.376).D-二聚体浓度、骨折类型和术前制动时间对DVT的发生率有影响,差异有统计学意义(P值分别为0.002、0.017、0.037).55例发生DVT的患者均顺利完成手术. 结论对于髋部骨折患者,年龄、性别对DVT的发生不具有临床意义,D-二聚体浓度、骨折类型和术前制动时间对DVT的发生有临床意义.放置下腔静脉滤器可确保骨折内固定手术及术后康复安全顺利进行.     

腹部手术后并发下肢深静脉血栓16例分析

目的　探讨腹部手术后并发下肢深静脉血栓形成 (DVT)的原因、诊治要点和预防措施。方法　回顾性分析 1 6例腹部手术后并发DVT病人的临床特点及诊断、治疗方法。结果　发生DVT的高危因素是复合创伤、恶性肿瘤、血粘度增高、老年病人、合并高血压病、糖尿病及术后常规应用止血药等。本组 1 6例均治愈 ,无一例发生肺栓塞等严重后果。结论　腹部手术后并发DVT者要积极早期治疗 ,对发生DVT的高危人群术前、术后应采取预防措施     

手术取栓与药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效比较

目的 评估手术取栓加药物溶栓与单纯药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效.方法 回顾性分析175例髂股型下肢深静脉血栓形成患者的临床资料,依据治疗方式的不同分为取栓组与溶栓组;手术取栓组85例,其中合并髂总静脉狭窄或闭塞的46例,选择于术或介入治疗,术后给予尿激酶、低分子肝素治疗.采取药物溶栓抗凝治疗90例,仪给予尿激酶、低分子肝素治疗.治疗前两组患者年龄、病程、肿胀程度及伴随疾病比较,差异无统计学意义(P＜0.05).结果 治疗后1个月,手术取栓组治愈率71.8%(61/85),双下肢周径差手术组由(4.6±1.6)cm下降为(0.8±0.5)cm;溶栓组治愈率38.9%(35/90);双下肢周径差由(4.0±1.9)cm下降为(1.8±1.3)cm.平均随访(28±11)个月,随访率64.6%,治疗后12个月,双下肢周径差手术组下降为(0.4±0.3)cm,溶栓组下降为(0.9±0.7)cm,手术组治愈率86.0%(49/57),溶栓组治愈率53.6%(30/56);手术组的下肢深静脉血栓形成后遗症发生率低于溶栓组(P＜0.05),手术组的静脉瓣功能异常的发生率低于溶栓组(P＜0.05).结论 急性髂股型下肢深静脉血栓形成手术取栓加溶栓疗效优于单纯药物溶栓.     

全髋关节置换术后深静脉血栓形成

目的：探讨全髋关节置换术后下肢深静脉血栓形成（DVT）的发生情况及预防治疗措施。方法：对220例（244髋）全髋关节置换患者围手术期皮下注射低分子肝素来预防治疗下肢深静脉血栓形成。术后第7天行彩色多普勒超声检查。结果：58例发生下肢深静脉血栓，其中远端血栓33例，近端血栓14例，全静脉血栓11例，DVT发生率26．4％，未发生1例肺栓塞。结论：围手术期低分子肝素应用可降低全髋关节置换术后DVT发生率，且安全可靠。     

门静脉和肠系膜上静脉血栓形成的介入治疗

目的评价介入技术治疗门静脉 (PV)和肠系膜上静脉 (SMV)血栓形成的安全性和效果。方法对 6例诊断为PV和SMV血栓形成的患者进行了经颈静脉途径经肝穿刺门静脉 (TIPS)介入治疗。经TIPS途径穿刺PV分支成功后插入导管做PV SMV造影 ,然后用 8F导管抽吸血栓 ,同时用“J”形导丝和猪尾形导管捣碎血栓 ,间断将尿激酶 (UK)经多侧孔导管注入PV和SMV。清除大部分血栓后 ,保留多侧孔导管至SMV内持续溶栓 3～ 13d。结果 6例治疗均成功 ,1例术后 12d死于腹腔脓肿。随访 4个月至 3年 ,5例健在 ,Doppler超声波复查显示PV和SV血流通畅 ,无血栓复发。结论经TIPS途径介入技术 ,包括用导管抽吸、捣碎血栓和局部溶栓治疗 ,是治疗急性症状性PV和SMV血栓形成的安全、有效方法     

血管腔内治疗下肢深静脉血栓形成

目的 探讨下肢深静脉血栓的介入联合手术的血管腔内治疗方法.方法 76例下肢深静脉血栓形成的患者,在数字减影血管造影术(digtal subtraction angiography,DSA)监视下行下腔静脉滤器置入,采用手术取栓,辅以临时性股动静脉瘘,取栓后即刻造影观察有无血栓残留及髂静脉病变情况.残留血栓在DSA监视下用双腔取栓管取栓或大的鞘管吸栓.对髂静脉狭窄大于60%的患者予以血管成形术,其中62例置入髂静脉支架.结果 支架置入技术成功率100%,1例死于腰升静脉破裂出血.71例患者得到随访,其中髂静脉支架患者60例,随访3～30个月,平均随访21个月.65例下肢肿胀明显缓解,发现血栓复发6例(8.45%,6/71)其中支架内血栓形成4例(6.66%,4/60),支架移位6例(10.0%,6/60),支架断裂1例(1.66%,1/60).结论 在DSA监视下,取栓联合髂静脉支架置入可提高取栓后静脉通畅率,是治疗下肢深静脉血栓的重要方法.