血管腔内介入治疗髂静脉压迫综合征45例分析

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摘要目的：探讨血管腔内介入治疗髂静脉压迫综合征（IVCS）的临床疗效。方法：对2008年4月至2015年4月本院行介入治疗的45例IVCS患者的临床资料进行回顾性分析，合并下肢静脉曲张38例，直接植入支架37例，行单纯髂静脉球囊扩张1例，合并下肢深静脉血栓形成后遗症（PTS）6例，直接植入支架5例，行单纯髂静脉球囊扩张1例，合并急性下肢深静脉血栓形成（DVT）3例，施行导管溶栓后存在髂静脉受压的患者植入支架2例，行单纯髂静脉球囊扩张1例；所有植入支架均为自膨式金属裸支架。手术前后测髂静脉狭窄率，以及患肢大小腿与健肢周径差。术后1、3、6个月及1、2年采用多普勒超声检查随访。结果：45例患者共植入支架47枚，直径6～14 mm，平均（12.7±2.7）mm，长度40～200 mm，平均（64.3±39.4）mm；3例急性病例采用植入下腔静脉滤器后导管溶栓（CDT），使用尿激酶量240～480万U，平均（400±138.6）万U；使用时间4～8 d，平均6.7 d；未发现肺动脉栓塞复发。治疗前髂静脉狭窄率为89.8%±8.2%（70.0%～100.0%），治疗后为4.0%±12.1%（0～70.0%），两者比较差异有统计学意义（P＜0.01）。手术前后大、小腿患肢与健肢比较，周径和肿胀明显消退（P＜0.001）。B超随访术后1、3、6个月及1、2年通畅率分别为95.5%、93.2%、93.2%、90.6%及90.6%。4例（占8.9%）患者术后穿刺点渗血，加压包扎后痊愈。1例（占2.2%）患者右髂静脉支架移位至右心室，后经抓捕器取出。随访1～24个月（平均16.8个月），4例患者髂静脉于不同时期再闭塞，PTS发生率为8.9%（4/45）。结论：介入治疗对各种原因的IVCS安全有效，支架治疗IVCS疗效满意。

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	黄崇青1
	虞冠锋1
	黄景勇1
	金昊2

关键词 ：髂静脉压迫综合征, 深静脉血栓形成, 支架, 导管溶栓

Abstract：Objective: To investigate the clinical effect of endovascular interventional treatment for iliac vein compression syndrome (IVCS). Methods: The data of 45 patients with IVCS, underwent interventional treatment from April 2008 to April 2015 in our hospital, were analyzed retrospectively. Among these patients, 38 cases complicated with lower extremity varicose veins, underwent stenting in 37 cases and iliac venous balloon dilation in 1 case. Complicated with post-thrombotic syndrome (PTS) in 6 cases, underwent stenting in 5 cases and iliac venous balloon dilation in 1 case. Complicated with acute deep venous thrombosis (DVT) in 3 cases, underwent catheter directed thrombolysis (CDT) and then stenting in 2 cases, underwent CDT with balloon dilatation in 1 case. All the stents were self-expanding stent. The stenosis rate of iliac vein and the perimeter difference between the suffered limb and healthy one were measured before and after operation. The patients were followed up with Duplex ultrasound in 1-, 3-, 6-month, 1-, and 2- year postoperatively, respectively. Results: A total of 47 stents were placed in 45 patients. The diameter and the length of stent was 6 to 14 mm (mean 12.7±2.7 mm) and 40-200 mm (mean 64.3±39.4 mm), respectively. CDT after inferior vena cava filtration in 3 cases with DVT, using urokinase with a dose of 240 to 480 (mean 400±138.6) million U for 4 to 8 (mean 6.7) days, without the recurrence of pulmonary embolism. The difference of iliac venous stenosis was statistically significant [89.8%±8.2% (70.0%-100.0%) vs 4.0%±12.1% (0-70.0%), P<0.01]. Perimeter differences of thigh and calf between the suffered limb and healthy one were significant before and after operation, too (P<0.001). The patency rates of 1-, 3-, 6- months, 1- and 2- year were 95.5%, 93.2%, 93.2%, 90.6% and 90.6%, respectively. Four patients (8.9%) suffered minor bleeding at puncture site and were treated with compression successfully. The only 1 patients (2.2%) underwent stenting of right iliac vein, complicated migration stent to the right ventricle, and arrested by Amplatz Goose Neck Snare and Kit, successfully. The incidence of PTS was 8.9% (4/45) during the follow-up of 1 to 24 (mean 16.8) months, caused by iliac venous occlusion in different periods. Conclusion: Interventional therapy for patients of IVCS is safe and effective. It is satisfactory of stent placement for IVCS.

Key words： iliac vein compression syndrome deep vein thrombosis stent catheter directed thrombolysis

收稿日期: 2015-06-05

基金资助:浙江省自然科学基金资助项目（LQ13H100003）。

通讯作者: 黄景勇，副主任医师，Email：wzhjy96@yahoo.com.cn。

作者简介: 黄崇青（1983-），男，浙江温州人，讲师，博士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I12/902

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