以下肢深静脉血栓为首发症状的恶性肿瘤患者28例临床分析

【摘要】　目的?分析以下肢深静脉血栓（DVT）为首发症状的恶性肿瘤患者的临床特点，探讨下肢DVT与肿瘤关系。方法?回顾性分析2013年5月至2018年5月收治的342例特发性（无明显诱因）DVT患者的临床资料。结果?住院及随诊期间诊断恶性肿瘤患者28例，占新诊断特发性DVT患者8.2%。结论?特发性DVT患者，尤其是多发血栓、溶栓效果欠佳伴凝血功能异常的患者应高度警惕恶性肿瘤的发生。

Simultaneous versus staged endovascular treatment of May-Thurner syndrome associated with varicose veins of left lower extremity:comparison of the therapeutic effect

Objective To evaluate the therapeutic efficacy of simultaneous endovascular therapy and staged endovascular therapy in treating May-Thurner syndrome associated with varicose veins of left lower extremity.Methods The clinical data of 37 patients with May-Thurner syndrome complicated by varicose veins of left lower extremity,who were admitted to authors’hospital to receive treatment during the period from September 2016 to March 2018,were collected.Of the 37 patients,23 received simultaneous treatment of left iliac vein stenosis and varicose veins(group A)and 14 received staged treatment(group B),i.e.the left iliac vein stenosis was treated first,and one month later the varicose vein was treated.The postoperative complications,hospitalization days,hospitalization expenses,and the iliac vein stent patency rate,lower limb swelling remission rate,pain relief rate,venous ulcer healing rate and venous clinical severity score(VCSS)of venous disease at 6 months after treatment were compared between the two groups.Results Successful endovascular treatment was achieved in all 37 patients.Postoperative subcutaneous congestion was observed in 2 patients of group A and one patient of group B.One patient in each group developed skin burns and wound infections.One patient in group A had skin rash of lower extremy,and one patient in group B had abnormal skin sensation of leg.No puncture point hemorrhage of left femoral vein,deep venous thrombosis of lower extremities,or pulmonary embolism occurred.The hospitalization days of group A and group B were(9.04±1.66)days and(15.71±2.02)days respectively,the hospitalization expenses in group A and group B were(3.58±0.63)and(4.11±0.46)ten thousand Chinese yuan respectively,and the differences in the above two indexes between group A and group B were statistically significant(P<0.05).The patients were followed up for 6 months,and no statistically significant differences in iliac vein stent patency rate,lower limb swelling relief rate,pain relief rate and venous ulcer healing rate existed between the two groups(P>0.05).No statistically significant differences in both preoperative and postoperative VCSS scores existed between the two groups(P>0.05),although in each group the difference in VCSS score between pre-treatment and posttreatment was statistically significant(P<0.05).Conclusion In treating patients with May-Thurner syndrome complicated by varicose veins of left lower extremity,the selection of simultaneous endovascular treatment or staged endovascular treatment will not affect the short-term curative effect,nevertheless,simultaneous endovascular treatment can reduce the hospitalization days and medical cost.