摘要
血栓性浅静脉炎(SVT)既往被认为是自限性疾病,因而在临床中很少受到关注,但近年来有大量研究结果表明其可能会诱发深静脉血栓生成甚至导致致死性肺栓塞。SVT的发病易感因素复杂,虽与深静脉血栓相似,但其临床表现多样,多发生于下肢,尤其是大隐静脉,主要与静脉曲张有关。而上肢SVT更多与医源性损伤相关。彩色多普勒超声现目前已成为诊断及评估SVT的首选检查方法。目前关于SVT的治疗国内外尚无统一意见,治疗目的主要是缓解临床症状和预防静脉血栓栓塞(VTE)与肺栓塞(PE)等并发症的发生。治疗手段包括:药物治疗、压力治疗、手术治疗及中医药治疗等。非甾体类抗炎药可以减轻SVT病人局部疼痛等症状,对于治疗浅静脉血栓、降低DVT及PE的发生率并没有重要作用。抗凝治疗现已成为SVT的首选治疗方案,ACCP指南推荐对于下肢病变>5 cm的SVT使用预防剂量的磺达肝素和低分子肝素优于无抗凝治疗,另对于其他高危因素如病变侵及隐股静脉交界处、病变发生在大隐静脉、疼痛等症状严重、近期手术、癌症病人、SVT复发及近期有VTE病史者,均建议抗凝治疗。手术治疗由于会造成PE等并发症的风险,目前并不推荐。
Superficial thrombophlebitis(SVT)was previously considered a self-limiting disease and received little attention in clinical practice.However recent research findings indicate its potential to cause deep vein thrombosis and even lifethreatening pulmonary embolism.The predisposing factors for SVT are complex resembling those of deep vein thrombosis but its clinical manifestations are diverse.predominantly occurring in the lower limbs.especially in the great saphenous vein.primarily associated with varicose veins.SVT in the upper limbs is more often related to iatrogenic injuries.Color Doppler ultrasound has become the preferred diagnostic method for SVT evaluation.Currently.there is no consensus on the treatment of SVT both domestically and internationally.The primary treatment goals are to alleviate clinical symptoms and prevent the occurrence of complications such as venous thromboembolism(VTE)and pulmonary embolism(PE).Treatment modalities include pharmacotherapy compression therapy surgical intervention and traditional Chinese medicine treatment.Nonsteroidal anti-inflammatory drugs can alleviate local pain in SVT patients but do not play a significant role in treating superficial venous thrombosis or reducing the incidence of deep vein thrombosis and PE.Anticoagulant therapy has become the preferred treatment for SVT.The ACCP guidelines recommend the use of prophylactic doses of heparin and low molecular weight heparin for SVT lesions exceeding 5 cm in the lower limbs and anticoagulant therapy is preferred over non-anticoagulant treatment.Additionally,anticoagulant therapy is recommended for other high-risk factors such as lesions involving the saphenofemoral junction lesions occurring in the great saphenous vein severe symptoms like pain recent surgeries cancer patients recurrent SVT and individuals with a recent history of VTE.Surgical treatment is currently not recommended due to the risk of complications such as pulmonary embolism.
作者
荆玉辰
辛世杰
JING Yu-chen;XIN Shi-jie(Department of Vascular Sur-gery/Thyroid Surgery,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2023年第12期1387-1390,共4页
Chinese Journal of Practical Surgery
基金
辽宁省教育厅基本科研项目青年项目(No.LJKQZ20222350)。
关键词
血栓性浅静脉炎
并发症
非甾体类抗炎药
抗凝治疗
superficial thrombophlebitis
complications
nonsteroidal anti-inflammatory drugs
anticoagulant therapy
