摘要
目的探讨髂腹股沟人路相关急性下肢深静脉血栓形成（deep venous thrombosis，DVT）的病因、临床特点及诊疗经验。方法回顾性分析河南省洛阳正骨医院2008年1月至2013年12月诊治的1l例髂腹股沟手术入路相关急性医源性下肢DVT患者的临床特点及治疗措施。结果11例复杂髋臼骨折病例，行髂腹股沟（ilioninguinal）入路手术7例，联合Kocher—Langenbeck入路4例，术后3d内并发患肢DVT，均经数字减影血管造影（digital subtraction angiography，DSA）证实了DVT与髂腹股沟入路手术关系密切，11例均在髂腹股沟段出现静脉狭窄，狭窄段远侧血栓形成9例，上下侧均有血栓形成2例，1例合并髂静脉广泛闭塞，1例合并股静脉广泛闭塞，均放置可回收型下腔静脉滤器，同期行经导管推注尿激酶接触溶栓治疗，溶栓治疗5—12d，平均（8．0±2．3）d，血栓完全溶解8例，少量残留3例，闭塞髂股静脉完全开通，随访6—18个月，平均（10±4）个月，无DVT复发及PTS发生。结论髂腹股沟入路手术可对术区髂股静脉造成严重影响，是导致急性下肢深静脉血栓形成的重要原因，下腔静脉滤器保护下接触溶栓疗效确切。
Objective To evaluate the treatment of ilioinguinal approach surgery associated acute iatrogenic deep venous thrombosis （DVT）. Methods The clinical data and treatment of 11 patients with ilioinguinal approach surgery associated acute iatrogenic DVT were analyzed. Results These 11 patients initially suffered from complicated aeetabulum fracture,7 cases were treated by single ilioinguinal approach surgery and the other 4 cases were combined with Kocher-Langenbeck approach. In 3 days after surgery, DVTs were found by Doppler sonography, and all the DVTs were proved having closed relationships with ilioinguinal approach through digital subtraction angiography（DSA） ： iliac-femoral veins appeared stenosis at ilioinguinal segment in all the 11 cases, DVTs were found distal to the stenosis in 9 cases, both sides in 2 cases （ 1 case combined extensive iliac vein emphraxis and the other case combined extensive femoral vein emphraxis）. After retrievable inferior vena cava filters were implanted, 11 patients received catheter-directed thrombolysis for 5 - 12 days. Complete thrombolysis was achieved in 8 cases and thrombi residual left in 3 cases. The iliac-femoral veins were recanalized completely. After （10 ± 4） month fellow-up, no DVT recurred and no PTS appeared. Conclusions Ilioinguinal approach surgery seriously effects iliac-femoral veins, and is a important precipitating factor of DVT. Early catheter-directed thrombolysis under the protection of inferior vena cava filter is an effective treatment.
出处
《中华普通外科杂志》
CSCD
北大核心
2015年第4期268-271,共4页
Chinese Journal of General Surgery
