髂股静脉血栓形成后综合征的早期手术治疗及相关实验研究

目的 动物实验分析髂股静脉血栓形成(IFVT)后纤溶激活和管壁重塑发生时间,确定髂股静脉血栓形成后综合征(irx,rs)的发生时间;对比分析早期和中晚期手术治疗IFPTS的疗效,探寻最佳手术时机.方法 建立大鼠IFVT模型,采用免疫组化方法检测管壁组织纤溶酶原激活物(tPA)和尿激酶型纤溶酶原激活物(uPA)表达.采用弹力、胶原纤维染色方法检测内弹力膜阳性率,血管周径和管壁僵硬指数.将1990年1月至2005年12月收治的51例接受大隐静脉交叉转流术的IFPTS患者分为早期治疗组(IFVT后1～2个月,n=21),中晚期治疗组(IFVT后>2个月,n=30).用下肢慢性静脉功能不全症状评分标准(VCSS)评估治疗效果.结果 大鼠静脉管壁tPA和uPA在IFVT后2周和4周表达明显增加(P<0.05).管壁内弹力膜阳性率在4、8和12周明显下降(P<0.01),血管周径在12周明显增大(P<0.05),管壁僵硬指数在4、8和12周明显上升(P<0.01).早期治疗组症状改善明显,术后和术前VCSS差异有统计学意义(3.4±0.9比5.2±1.1,P<0.05),中晚期治疗组症状变化无统计学意义(6.8±1.7比7.6±3.0,P>0.05).结论 IFFTS发生时间在血栓形成后1个月左右.IFVT后1～2个月是大隐静脉交叉转流术治疗IFFIS的最佳手术时机.

Early surgery for iliac-femoral post-thrombotic syndrome and related experimental study

Objectives To confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein "thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment Methods IFVT was performed on 20 SD rats. The plasminogen activation tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA) ] and vascular remodeling ( positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group ( >2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS). Results The positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P <0. 01), while the vessel wall stiffness index increased at the same time (P < 0. 01). The vascular perimeter elevated obviously at 12th week (P <0. 05). Symptoms of early treatment group improved significantly after surgery (3.4 0. 9 us. 5. 2 1.2, P <0. 05). Whereas the late treatment group had no significant changes of symptoms (6. 8 1. 7 vs. 7. 6 3.0, P > 0. 05). Conclusions The present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.