介入结合手术治疗各期下肢深静脉血栓形成的体会

目的初步探讨和总结手术结合介入在治疗下肢深静脉血栓形成(DVT)中的疗效。方法回顾性分析近2年来手术结合介入治疗的40例下肢DVT患者共42条肢体的方法和效果,其中髂股静脉主干陈旧性铸型血栓8例,髂总静脉开口狭窄或闭塞继发新鲜血栓25例,单侧新鲜血栓5例,滤器置入后继发下腔静脉及双下肢新鲜血栓2例。主要使用患肢股静脉切开,介入下取栓并结合球囊扩张和(或)支架术。结果40例患者下腔静脉及深静脉全部开通。其中髂静脉支架置入19例;球囊扩张14例;人工血管置换股静脉1例。平均随访10个月,全部患者患肢症状明显改善,彩色多普勒或造影示患侧深静脉血流通畅。结论手术结合介入治疗深静脉血栓具有良好效果,值得进一步研究和推广。

Experience of intervention combined with surgery in treatment of different stage deep venous thrombosis of lower extremity

Objective To evaluate the preliminary probe into the curative effect of combination treatment of surgery and intervention for lower limb deep venous thrombosis. Methods The therapeutic methods and effects of 40 patients with 42 occluded limbs during the last two years, including iliac-femoral trunk old cast thrombosis in 8 cases, secondary new thrombosis with obstruction or narrow opening of iliac veins in 25, unilateral new thrombosis in 5 and secondary new thrombosis after inferior vena cava fliter placement in 2; were retrospectively analyzed. The main procedure included incision of the affected femoral veins, interventional embolectomy combined with balloon dilatation and/or stenting. Results All the affected inferior vena cavas and deep veins of lower limb were totally reconelized and patent successfully, including iliac venous stenting in 19 patients, balloon dilatation in 14 and prosthesis implantation in 1. In the mean follow-up of 10 months, all the patients showed obvious improvement of clinical presentation, with color Doppler or angiography demonstrating blood flow fluently. Conclusions The combination of intervention and surgery has good efficency in treatment of thrombosis of deep veins of lower extremity, deserving deeper reaserch and recommendation.