摘要目的 探索包括抗凝、下腔静脉滤器置入、机械性血栓清除、髂静脉球囊成形支架置入、置管溶栓(catheter-directed thrombolysis,CDT)在内的综合治疗方案在治疗左髂静脉压迫并发急性左髂股静脉血栓形成中的意义.方法 回顾性收集、分析首都医科大学附属北京潞河医院2013年3月至2019年3月期间收治的61例左髂静脉压迫并发急性左髂股静脉血栓形成患者的临床资料及随访数据.患者依据治疗方案分为传统治疗方案组(抗凝或抗凝联合CDT组)、综合治疗方案组.比较不同治疗方案组患者的短期静脉通畅率评分、远期左股静脉近端瓣膜功能之间的差异,采用生存分析比较不同治疗方案组患者远期下肢静脉血栓后综合征发生率的差异.结果 综合治疗方案组患者短期静脉通畅率评分高于传统治疗方案组(t =9.872,P＜0.001).综合治疗方案组深静脉血栓后综合征(PTS)发生率低于传统治疗方案组(x2=7.146,P=0.008).综合治疗方案组左股静脉瓣膜功能优于传统治疗方案组(x2=23.834,P＜0.001).结论 抗凝基础上的包括下腔静脉滤器置入、机械性血栓清除、髂静脉球囊成形支架置入、CDT在内的综合治疗方案可有效减少左髂静脉压迫并发急性左髂股静脉血栓形成患者远期下肢静脉血栓后综合征发生,改善生活质量.

abstractsObjective To explore the significance of comprehensive treatment including anticoagulation,inferior vena cava filter implantation,mechanical thrombectomy,iliac vein angioplasty and stent placement and catheter-directed thrombolysis (CDT) in the treatment of acute iliac femoral vein thrombosis on the basis of left iliac vein compression.Methods In this study 61 patients were enrolled at Beijing Luhe Hospital,Capital Medical University between Mar 2013 and Mar 2019 in anticoagulation combined with CDT group and comprehensive treatment group.Short-term venous recanalization rate scores and long-term proximal valvular function of left femoral vein were compared.The survival curve was drawn using kaplan-meier method,and incidence of PTS was compared with the Log rank test.Results The short-term venous recanalization rate scores of the patients in the comprehensive treatment group were higher than scores of the patients in the traditional treatment group(t =9.872,P ＜ 0.001).16 patients developed PTS.The incidence of PTS in the comprehensive treatment group was lower than that in the traditional treatment group(x2 =7.146,P =0.008).Patients in comprehensive treatment group kept a better function of the proximal valvular of left femoral vein than patients in the traditional treatment group (x2 =23.834,P ＜0.001).Conclusions The comprehensive treatment can effectively reduce the occurrence of long-term PTS in patients with acute iliac femoral vein thrombosis complicated with left iliac vein compression,and improves the quality of patients' life.