髂静脉支架在下肢深静脉血栓形成治疗中的应用

Application of iliac vein stent in treatment of deep venous thrombosis in lower extremities

摘要:

目的 评价髂静脉支架在急性期下肢深静脉血栓形成伴有髂静脉狭窄或者闭塞的治疗中的应用效果。方法 回顾性分析2016年1月至2018年1月山东省潍坊市人民医院收治并行腔内治疗的急性下肢深静脉血栓形成伴髂静脉狭窄或闭塞患者80例。根据手术是否行髂静脉支架植入治疗,分为观察组45例和对照组35例。观察组通过置入下腔静脉滤器+导管接触性溶栓(CDT)+髂静脉支架治疗；对照组采用置入下腔静脉滤器+CDT治疗。对比2组患者术后效果、患肢消肿率、静脉通畅率分别为及流行病学和经济研究-生活质量/症状(VEINES-QOL/SYM)问卷调查评分。采用SPSS 18.0统计软件进行统计分析。结果 术前,2组大腿、小腿周径差比较,差异均无统计学意义(均P>0.05)；术后,2组大腿、小腿周径差及消肿率比较,差异均有统计学意义(均P<0.05)。随访1、3、6、12个月后,观察组静脉通畅率分别为45例(100.0%)、43例(95.5%)、41例(91.1%)及41例(91.1%),对照组分别为29例(82.8%)、27例(77.1%)、26例(74.2%)及 25例(71.4%),差异均有统计学意义(均P<0.05)。观察组与对照组的下肢深静脉血栓后遗症发生率分别为0(0.00%)与4例(11.43%),差异有统计学意义(P<0.05)。观察组与对照组的DVT复发率分别为4例(8.89%)与5例(14.28%),差异无统计学意义(P>0.05)。治疗前,2组患者VEINES-QOL/SYM评分比较,差异均无统计学意义(均P>0.05)；治疗后,2组患者VEINES-QOL/SYM评分比较,差异均有统计学意义(均P<0.05)。结论 髂静脉支架在急性期下肢深静脉血栓形成伴有髂静脉狭窄或者闭塞的治疗中的应用效果优于单纯置管溶栓。

Abstract:

Objective To evaluate the efficacy of iliac vein stent in the treatment of acute deep venous thrombosis (DVT) in the lower limbs with iliac vein stenosis or occlusion. Methods A retrospective analysis was made of 80 patients hospitalized for acute DVT in the lower extremities with iliac vein stenosis or occlusion at Weifang People′s Hospital of Shandong Province from January 2016 to January 2018. According to the implantation of iliac vein stent, they were divided into observation group (n=45) and control group (n=35). The observation group underwent implantation of inferior vena cava filter, catheter-directed thrombolysis (CDT), and iliac vein stent; the control group were treated with an inferior vena cava filter and CDT. The two groups were compared for the postoperative effect, detumescence rate of the affected limbs, venous patency rate, and scores on Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) questionnaire. Statistical analysis was performed using SPSS statistics 18.0. Results Before operation, circumference differences in the thigh and calf between the two groups were not statistically significant (P>0.05 for both); after operation, circumference differences in the thigh and calf and difference in the detumescence rate between the two groups was statistically significant (P<0.05 for all). The observation group had higher venous patency rates than the control group at 1,3, 6, and 12 months of follow-up [45(100.0%) vs 29(82.8%), 43(95.5%) vs 27(77.1%), 41(91.1%) vs 26(74.2%), and 41(91.1%) vs 25(71.4%) respectively], the differences being statistically significant (P<0.05 for all). There was a statistically significant difference in the incidence of sequelae of DVT between the observation group and the control group [0(0.00%) vs 4(11.43%), P<0.05]. There was no significant difference in the rate of thrombosis recurrence between the two groups [4(8.89%) vs5(14.28%), P>0.05]. VINENES-QOL/SYM questionnaire scores of the two groups were not significantly different before the treatment (P>0.05) but were significantly different after the treatment (P<0.05). Conclusion Implantation of iliac vein stent is more effective than catheter-directed thrombolysis in the treatment of DVT of the lower extremity with iliac vein stenosis or occlusion.