Cockett综合征并发急性下肢深静脉血栓的外科治疗

目的：总结Cockett综合征并发下肢深静脉血栓的外科治疗经验，探讨有效治疗下肢深静脉血栓的外科方法。方法：采用外科手术方法共治疗Cockett综合征并发下肢深静脉血栓患者42例，其中取栓 左髂总静脉闭塞段切除、人工血管原位移植15例，取栓 左髂外静脉→下腔静脉搭桥6例，取栓 左股总静脉→下腔静脉搭桥7例，取栓 Palma手术14例；除原位移植外，所有患者加作临时性股静脉瘘。结果：全组无手术死亡及肺动脉栓塞发生，42例患者除3例患肢消肿不明显外，其余患者均取得了良好疗效。随访2月-6a，4例人工血管内血栓形成，6例吻合口狭窄，血栓后综合征发生率为16，67％。结论：Cokett综合征极易并发急性下肢深静脉血栓，外科治疗下肢深静脉血栓时要高度警惕左髂总静脉病变并彻底矫正，选择合理有效的术式是提高远期通畅率、降低血栓后综合征发生率的关键。

Surgical Management of Acute Deep Venous Thrombosis of Lower Extremity Complicated by Cockett Syndrome

Objective:To summarize the experience of surgical management of acute deep venous thrombosis of the lower extremity with cockett syndrome and to explore the effective surgical treatment for acute deep venous thrombosis.Methods:42 cases treated by surgery were studied.Among these patients,6 were treated by thrombectomy and shunt from left external iliac vein to inferior vein cava,7 were treated by thrombectomy and shunt from left common femoral vein to inferior vein cava,14 were treated by thromectomy and Palma procedure and 15 were treated by thrombectomy and occlusive segment resection in left common iliac vein and in-situ transplant with artificial graft.All the patients were performed temporary arteriovenous fistula except those treated by in-situ transplant.Results:Among the 42 patients,3 demonstrated no obvious edema relief;other patients achieved good results.During the follow-up of 2-72 months,4 cases of artificial graft developed thrombosis and 6 cases anastomsis strictune.The post-thrombosis rate was 16.67%.Conclusion:Cockett syndrome combines acute DVT of lower extremity easily.We should be conscious of left common iliac venous disorder when treating deep venous thrombosis of lower extremity by surgery and modify it completely.Selection of rational and effective procedure is very important in increasing the long-term patency rate and decreasing the post-thrombosis syndrome rate.