应用外科方法治疗下腔静脉系统血栓形成

Y. Khrebtiy, G. I. Khrebtiy
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摘要

目标。探讨下腔静脉系统急性深静脉血栓(DVT)的外科治疗策略。材料和方法。我们分析了2001年至2014年181例深静脉血栓患者的手术治疗结果。本组DVT患者中,37例(20.4%)患者存在下腔静脉血栓形成。另外,我们选择了44例漂浮性深静脉血栓患者。在治疗过程中,60例(33.1%)患者采用导管溶栓(CDT), 30例(16.5%)患者采用全身溶栓,44例(24.3%)患者采用取栓术,47例(25.9%)患者采用抗凝药物。30例患者采用导管定向溶栓。结果。在对方法效率的总体评估中,我们发现该专利方法的效率比足后静脉溶栓效率高20.5%,比全身溶栓效率高39% (p<0.001)。在我们的研究中,60例CDT中有2例(3.3%)发生出血性并发症。在治疗漂浮性DVT患者时,当漂浮部分长度大于4cm时,我们采用积极的手术策略。在静脉闭塞性血栓的治疗中,导管溶栓9例,全身溶栓4例,肺栓塞(PE)溶栓1例。1例下腔静脉血栓患者在抗凝治疗期间死于大量PE。采用DVT联合方法治疗下腔静脉系统,166例(92%)患者的近期疗效良好,90例(49.7%)患者的长期疗效良好。下腔静脉系统血栓形成的治疗策略需要在每个具体病例中采用单独的方法,考虑到疾病的病因,下腔静脉系统结构的解剖特征,从疾病开始的术语,肺栓塞(PE)的风险,伴随病理的存在。
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USE OF SURGICAL METHODS OF TREATMENT FOR THROMBOSIS OF THE INFERIOR VENA CAVA SYSTEM
Objective. Develop surgical tactics in the treatment of acute deep venous thrombosis (DVT) of the inferior vena cava system.Materials and methods. We analyzed the results of the surgical treatment of 181 patients with DVT for the period from 2001 to 2014. Among the patients with DVT in our study, 37 (20.4%) patients had thrombosis of the inferior vena cava (IVC). Separately, we selected a group of 44 patients with floating DVT. During the treatment, catheter-directed thrombolysis (CDT) was used in 60 (33.1%) patients, systemic thrombolysis in 30 (16.5%), thrombectomy was performed in 44 (24.3%) patients, and anticoagulants were used in 47 (25.9%) patients. Catheter-directed thrombolysis was performed according to the developed method in 30 patients. Results. In the general assessment of the efficiency of the methods, we found that the efficiency of the patented method is 20.5% greater than the efficiency of thrombolysis in the back vein of the foot and 39% greater than the efficiency of systemic thrombolysis (p<0.001). In our study, out of 60 cases of CDT, hemorrhagic complications occurred in 2 (3.3%) cases. In the treatment of patients with floating DVT, we used active surgical tactics when the length of the floating part was more than 4 cm. In the treatment of occlusive thrombosis of the IVC, catheter-directed thrombolysis was used in 9 patients, systemic thrombolysis in 4 patients, and thrombolysis for pulmonary embolism (PE) in 1 patient. 1 patient with thrombosis of the vena cava inferior died of massive PE during anticoagulant therapy. The use of combined methods of DVT treatment of the IVC system made it possible to obtain good and satisfactory results in the immediate period in 166 (92%) patients and in the long-term period in 90 (49.7%) patients.Conclusions. Treatment tactics for thrombosis of IVC system requires an individual approach in each specific case, taking into account the etiological factors of the disease, anatomical features of the structure of IVC system, terms from the onset of the disease, the risk of pulmonary embolism (PE), the presence of concomitant pathology.
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