下肢深静脉取栓术后并发症的处理

目的探讨下肢深静脉血栓形成(DVT)手术取栓的并发症及处理。方法对143例DVT行Fogarty导管取栓术,并附加大隐静脉置管区域抗凝溶栓;如合并髂静脉狭窄或闭塞同时给予处理。结果术后DVT总复发率12·6%(18/143),未行区域性溶栓、抗凝者复发率为29·8%(14/47),反之复发率为4·2%(4/96)(P<0·01),合并Cockett综合征者复发率为18·9%(14/74),而无Cockett综合征者复发率为5·8%(4/69)(P<0·01),切口淋巴瘘发生率2·8%(4/143),肺栓塞0·7%(1/143),下腔静脉滤器血栓形成0·7%(1/143),大出血0·7%(1/143),切口感染0·7%(1/143)。围手术期死亡率2·1%(3/143)。结论积极处理髂静脉病变、区域抗凝溶栓可降低DVT复发率;取栓术应列为DVT的首选治疗方法。

Complications of thrombectomy for deep vein thrombosis of the lower extremity

Objective To evaluate the complicatio ns after thrombectomy for deep vein thrombosis (DVT) of the lower extremity. Methods Thrombectomy was under taken for 143 patients using Fogarty catheter, then local thrombolysis and antic oagulation was undertaken by a indwelling catheter in the great saphenous vein. Results The total recurren ce rate of DVT was 12.6%(18/143), whereas the early recurrence rate without loc al thrombolysis and anticoagulation was 29.8%(14/47). The recurrence rate was 1 8.9%(14/74) against the background of Cockett syndrome, and 5.8%(4/69) withou t Cockett syndrome. Other complications included lymphatic fistula in 4 cases (2 .8%), pulmonary embolism, vena cava thrombosis, massive haemorrhage, and incisi onal infection in one each, death ensued in 3 (2.1%). ConclusionsThe recurrence rate of DVT could be low ered by management of the stenosis or occlusion of common iliac vein and local thrombolysis and anticoagulation. Thrombectomy should be the first choice of the rapy for DVT.