Cockett综合征合并急性期血栓的治疗疗效以及对策
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摘要
目的分析Cockett综合征合并急性下肢深静脉血栓形成(DVT)的不同治疗手段的疗效,探讨滤器植入是否常规,寻找更加合理治疗方法。方法回顾性分析郑州大学第一附属医院2014年8月-2016年4月期间就诊的89例Cockett综合征并发急性下肢DVT患者,按治疗方式分为实验组(A、B组)和对照组(C组)。A组36例均行下腔滤器植入+置管溶栓,其中11例行球扩,16例行球扩+支架;B组22例均行置管溶栓,其中7例行球扩,11例行球扩+支架,C组31例行系统溶栓保守治疗,术后给予抗凝、活血、消肿、穿弹力袜,院外均口服华法林继续抗凝,观察各组治疗疗效及血栓相关事件发生率。结果 87例获得随访,随访时间为3~20个月。A和B组有效率均为100%,C组有效率为80%,均未出现肺栓塞,无疾病相关死亡病例,实验组中A组与B组肺栓塞发生率及治疗疗效差异均无统计学意义(P>0.05)。实验组和对照组比较,实验组症状均得到明显缓解,对照组中6例肢体缓解不明显,疗效差异有统计学意义(P<0.05);血栓后遗症发生率差异有统计学意义(P<0.05),实验组低于对照组。结论对于Cockett综合征合并急性期血栓治疗,不常规植入下腔静脉滤器也是安全有效的;腔内治疗较药物系统溶栓中远期效果好,通畅率高,发生血栓后综合征风险明显降低。
Objective To analyze the efficacy of different therapies for Cockett syndrome complicated with acute deep venous thrombosis(DVT) of the lower limbs, and to explore whether the conventional filter placement is needed, and look for a more rational treatment. Methods A retrospective analysis of 89 cases who had Cockett syndrome with acute DVT of the lower limbs and treated in our hospital from August 2014 to April 2016. According to the treatment they were divided into experimental groups(A and B) and control group(C). The 36 patients in the group A underwent inferior vena cava filter placement and catheter thrombolysis, of which 11 cases underwent balloon dilatation, 16 cases underwent balloon expansion and stenting. The 22 patients in the group B underwent catheter thrombolysis, of which 7 cases underwent balloon dilatation, 11 cases were treated by balloon expansion and stenting. The 31 patients in the group C received systemic thrombolytic therapy, which was followed by anticoagulation, circulation-activation, detumescence and compression stockings therapy, and continuous anticoagulation therapy with Warfarin. The curative effect and the incidence of thrombosis event were observed. Results Of the 89 cases, 87 were followed up for 3-20 months with an average of 8-9 months. The effective rate was 100% in the groups A and B and 80% in the group C. There was no pulmonary embolism or disease-related deaths. There was no significant difference in the incidence of pulmonary embolism or treatment efficacy between the experimental groups A and B(P > 0.05). The symptoms were significantly alleviated in all the patients of the experimental group,6 cases in the control group did not have obvious limb remission, the efficacy was significantly different(P < 0.05).The incidence of thrombosis sequelae in the experimental group was significantly lower than that in the control group(P < 0.05). Conclusions For the treatment of Cockett syndrome with acute DVT of the lower limbs, unconventional implantation of the inferior vena cava filter is safe and effective. Compared with systemic thrombolytic therapy,endovascular treatment has better long-term effect, higher patency rate, and lower risk of post-thrombotic syndrome.
Objective To analyze the efficacy of different therapies for Cockett syndrome complicated with acute deep venous thrombosis(DVT) of the lower limbs, and to explore whether the conventional filter placement is needed, and look for a more rational treatment. Methods A retrospective analysis of 89 cases who had Cockett syndrome with acute DVT of the lower limbs and treated in our hospital from August 2014 to April 2016. According to the treatment they were divided into experimental groups(A and B) and control group(C). The 36 patients in the group A underwent inferior vena cava filter placement and catheter thrombolysis, of which 11 cases underwent balloon dilatation, 16 cases underwent balloon expansion and stenting. The 22 patients in the group B underwent catheter thrombolysis, of which 7 cases underwent balloon dilatation, 11 cases were treated by balloon expansion and stenting. The 31 patients in the group C received systemic thrombolytic therapy, which was followed by anticoagulation, circulation-activation, detumescence and compression stockings therapy, and continuous anticoagulation therapy with Warfarin. The curative effect and the incidence of thrombosis event were observed. Results Of the 89 cases, 87 were followed up for 3-20 months with an average of 8-9 months. The effective rate was 100% in the groups A and B and 80% in the group C. There was no pulmonary embolism or disease-related deaths. There was no significant difference in the incidence of pulmonary embolism or treatment efficacy between the experimental groups A and B(P > 0.05). The symptoms were significantly alleviated in all the patients of the experimental group,6 cases in the control group did not have obvious limb remission, the efficacy was significantly different(P < 0.05).The incidence of thrombosis sequelae in the experimental group was significantly lower than that in the control group(P < 0.05). Conclusions For the treatment of Cockett syndrome with acute DVT of the lower limbs, unconventional implantation of the inferior vena cava filter is safe and effective. Compared with systemic thrombolytic therapy,endovascular treatment has better long-term effect, higher patency rate, and lower risk of post-thrombotic syndrome.
引文
[1]YAMAKI T,HAMATHATA A,SOEJIMA K,et al.Factors predicting development of post-thrombotic syndrome in patients with a first episode of deep vein thrombosis:preliminaryreport[J].Eur J Vasc Endovasc Surg,2011,41(1):126-133.
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[3]张青云,高建国,陈泳,等.综合介入治疗在38例下肢深静脉血栓形成中的临床分析[J].重庆医学,2011,40(8):816-818.
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[6]李晓强,桑鸿飞,戎建杰,等.介入治疗髂静脉狭窄或闭塞的远期效果观察[J].中国血管外科杂志:电子版,2010,2(1):21-23.
[7]李晓强,段鹏飞,钱爱民,等.介入联合手术治疗急性下肢深静脉血栓形成[J].中国普通外科杂志,2006,21(9):660-661.
[8]MEWISSEN M W,SEABROOK G R,MEISSNE MHR,et al.Haughton Catheter-directed thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J].Radiology,1999,4(211):39-49.
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[10]PROTACK C D,BAKKEN A M,PATEL N,et al.Davies.Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement[J].J Vasc Surg,2007,45(5):992-997.
[11]HALIL B,CELAL C,SERKAN E,et al.Endovascular treatment of iliac vein compression(may-thurner)syndrome:angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis[J].Ann Vasc Dis,2015,8(1):21-28.
[12]MEISSNER M H,GLOVICZKI P,COMEROTA A J,et al.Early thrombus removal strategies for acute deep venous thrombosis:clinical practice guidelines of the society for vascular surgery and the american venous forum[J].J Vasc Surg,2012,55:1449-1462.
[13]BEYTH R J,COHEN A M,LANDEFELD C S.Long-term outcomes of deep-vein thrombosis[J].Arch Intern Med,1995,155(10):1031-1037.
[14]KAHN S R,SHBAKLO H,LAMPING D L,et al.Determinants of health-related quality of life during the 2 years following deep vein thrombosis[J].J Thromb Haemost,2008,6(7):1105-1112.
[15]KAHN S R,SHRIER I,JULIAN J A,et al.Determinants and time course of the post-thrombotic syndrome after acute deep venous thrombosis[J].Ann Intern Med,2008,149(10):698-707.
[16]HULL R D,MARDER V J,MAH A F,et al.Quantitative assessment of thrombus burden predicts the outcome of treatment for venous thrombosis:a systematic review[J].Am J Med,2005,118(5):456-464.
[17]ENDEN T,HAIG Y,KL覫W N E,et al.Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis(the Ca Ven T study):a randomised controlled trial[J].Lancet,2012,379(9810):31-38.
[2]赵军,董国祥.左髂总静脉狭窄与急性深静脉血栓形成[J].中华实验外科,1998,36:12-14.
[3]张青云,高建国,陈泳,等.综合介入治疗在38例下肢深静脉血栓形成中的临床分析[J].重庆医学,2011,40(8):816-818.
[4]MAHNKEN A H,THOMSON K,DE HAAN M,et al.CIRSEstandards of practice guidelines on iliocaval stenting[J].Cardiovasc Intervent Radiol,2014,37(4):889-897.
[5]万圣云,徐周纬,丁洋,等.下肢深静脉血栓形成的综合治疗[J].中国普通外科杂志,2009,18(12):1255-1258.
[6]李晓强,桑鸿飞,戎建杰,等.介入治疗髂静脉狭窄或闭塞的远期效果观察[J].中国血管外科杂志:电子版,2010,2(1):21-23.
[7]李晓强,段鹏飞,钱爱民,等.介入联合手术治疗急性下肢深静脉血栓形成[J].中国普通外科杂志,2006,21(9):660-661.
[8]MEWISSEN M W,SEABROOK G R,MEISSNE MHR,et al.Haughton Catheter-directed thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J].Radiology,1999,4(211):39-49.
[9]VEDANTHAM S,THORPE P E,CARDELLA J F,et al.Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J].J Vasc Interv Radiol,2009,20(7):227-239.
[10]PROTACK C D,BAKKEN A M,PATEL N,et al.Davies.Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement[J].J Vasc Surg,2007,45(5):992-997.
[11]HALIL B,CELAL C,SERKAN E,et al.Endovascular treatment of iliac vein compression(may-thurner)syndrome:angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis[J].Ann Vasc Dis,2015,8(1):21-28.
[12]MEISSNER M H,GLOVICZKI P,COMEROTA A J,et al.Early thrombus removal strategies for acute deep venous thrombosis:clinical practice guidelines of the society for vascular surgery and the american venous forum[J].J Vasc Surg,2012,55:1449-1462.
[13]BEYTH R J,COHEN A M,LANDEFELD C S.Long-term outcomes of deep-vein thrombosis[J].Arch Intern Med,1995,155(10):1031-1037.
[14]KAHN S R,SHBAKLO H,LAMPING D L,et al.Determinants of health-related quality of life during the 2 years following deep vein thrombosis[J].J Thromb Haemost,2008,6(7):1105-1112.
[15]KAHN S R,SHRIER I,JULIAN J A,et al.Determinants and time course of the post-thrombotic syndrome after acute deep venous thrombosis[J].Ann Intern Med,2008,149(10):698-707.
[16]HULL R D,MARDER V J,MAH A F,et al.Quantitative assessment of thrombus burden predicts the outcome of treatment for venous thrombosis:a systematic review[J].Am J Med,2005,118(5):456-464.
[17]ENDEN T,HAIG Y,KL覫W N E,et al.Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis(the Ca Ven T study):a randomised controlled trial[J].Lancet,2012,379(9810):31-38.