中国普外基础与临床杂志

中国普外基础与临床杂志

血栓性髂静脉狭窄的诊疗现状与趋势

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目的 总结近年来血栓性髂静脉狭窄的诊断和治疗方法。 方法 收集近 5 年相关文献资料,对血栓性髂静脉狭窄诊断与治疗的现状与趋势进行综述。 结果 关于血栓性髂静脉狭窄的诊断方法,目前主要有多层螺旋 CT、静脉造影、腔内超声、磁共振成像、彩色多普勒超声等影像学检查,这些方法各有利弊;血栓性髂静脉狭窄的治疗方法较多,以腔内治疗为主。然而急性血栓性髂静脉狭窄患者是否需要放置滤器、是否需要支架植入、如何放置支架以及狭窄处理时机目前仍无统一标准;慢性血栓性髂静脉狭窄患者何时、怎样有效干预目前亦无定论。 结论 血栓性髂静脉狭窄发病率高,后遗症严重,早诊断、合理治疗至关重要。只有严格把握适应证,综合医生技术水平与病情,采取恰当的治疗策略,才能使患者受益最大化。

Objective To summarize strategy of diagnosis and treatment of thrombotic iliac vein stenosis in recent years. Method The relevant literatures in recent 5 years on current status and trend of diagnosis and treatment of the thrombotic iliac vein stenosis were reviewed. Results At present, the diagnostic methods of thrombotic iliac vein stenosis mainly included that the multi-slice spiral CT, venography, intracavitary ultrasound, magnetic resonance imaging, color Doppler ultrasound and other imaging examinations, each of which has its advantages and disadvantages. There were still no uniform criteria for that whether a filter should be placed, whether the stents should and how to be placed, and when to intervene in the patients with acute thrombotic iliac vein stenosis. There was no definite conclusion about when and how to effectively intervene in the patients with chronic thrombotic iliac vein stenosis. Conclusions Incidence of thrombotic iliac vein stenosis is high and sequela is severe. Early diagnosis and reasonable treatment are very important. Only strictly grasping indications, combining medical technology and patient’s condition, and adopting appropriate treatment strategy, can make patients’ maximal benefit.

关键词: 深静脉血栓形成; 髂静脉受压综合征; 髂静脉狭窄

Key words: deep venous thrombosis; iliac vein compression syndrome; iliac vein stenosis

1. Virchow R. Uber die erweiterung kleiner gefasse. Arch Pathol Anat, 1851, 3: 4279.
2. Lugo-Fagundo C, Nance JW, Johnson PT, et al. May-Thurner syndrome: MDCT findings and clinical correlates. Abdom Radiol (NY), 2016, 41(10): 2026-2030.
3. LIN OY, Lu GM. Underlying anatomy and typing diagnosis of May-Thurner syndrome and clinical significance: an observation based on CT. Spine (Phila Pa 1976), 2016, 41(21): E1284-E1291.
4. Kalu S, Shah P, Natarajan A, et al. May-thurner syndrome: a case report and review of the literature. Case Rep Vasc Med, 2013, 2013: 740182.
5. May R. The cause of predominantly sinistral occurrence of thrombosis of the pelvic veins. Minerva Cardioangiol Eur, 1957, 3(4): 346-349.
6. Narayan A, Eng J, Carmi L, et al. Iliac vein compression as risk factor for left-versus right-sided deep venous thrombosis: case-control study. Radiology, 2012, 265(3): 949-957.
7. 陈锋, 郭慧, 朱仙花, 等. 左髂静脉受压与左下肢深静脉血栓的相关性研究. 中华普通外科杂志, 2014, 29(12): 897-900.
8. Kim D, Orron DE, Porter DH. Venographic anatomy, technique and interpretation//Kim D, Orron DE (eds). Peripheral vascular imaging and intervention. St Louis, MO: Mosby-Year Book, 1992: 269-349.
9. Ibrahim W, Al Safran Z, Hasan H, et al. Endovascular management of May-thurner syndrome. Ann Vasc Dis, 2012, 5(2): 217-221.
10. 周瀚, 梁鲁, 姚碧辉, 等. 下肢深静脉血栓稳定性的研究现状及展望. 中国普外基础与临床杂志, 2017, 24(4): 525-528.
11. 王利新, 符伟国. 腔内超声在髂静脉受压综合征腔内治疗中的应用价值. 血管与腔内血管外科杂志, 2015, 1(1): 16-19.
12. Canales JF, Krajcer Z. Intravascular ultrasound guidance in treating May-Thurner syndrome. Tex Heart Inst J, 2010, 37(4): 496-497.
13. Birn J, Vedantham S. May-Thurner syndrome and other obstructive iliac vein lesions: meaning, myth, and mystery. Vasc Med, 2015, 20(1): 74-83.
14. 李高阳, 张丹. 左侧髂总静脉与下腔静脉延长线夹角的大小与左侧髂总静脉压迫的相关性研究. 临床放射学杂志, 2018, 37(3): 472-475.
15. 沈莉, 顾建平, 殷信道, 等. 202 例无下肢静脉疾病者左髂总静脉受压的 MSCTA 研究. 医学影像学杂志, 2013, 23(1): 130-134.
16. Rabinovich A, Ducruet T, Kahn SR, et al. Development of a clinical prediction model for the postthrombotic syndrome in a prospective cohort of patients with proximal deep vein thrombosis. J Thromb Haemost, 2018, 16(2): 262-270.
17. 张希全, 王义平, 朱伟, 等. 微创腔内治疗急性下肢深静脉血栓和髂静脉严重狭窄及闭塞. 中国普外基础与临床杂志, 2013, 20(4): 412-417.
18. Bozkaya H, Cinar C, Ertugay S, et al. Endovascular treatment of iliac vein compression (May-Thurner) syndrome: angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis. Ann Vasc Dis, 2015, 8(1): 21-28.
19. 宋燕, 方超, 付一群, 等. Cockett 综合征合并急性期血栓的治疗疗效以及对策. 中国现代医学杂志, 2017, 27(19): 83-86.
20. Vedantham S, Thorpe PE, Cardella JF, et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol, 2006, 17(3): 435-447.
21. Avgerinos ED, Hager ES, Jeyabalan G, et al. Inferior vena cava filter placement during thrombolysis for acute iliofemoral deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2014, 2(3): 274-281.
22. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南 (第三版). 中华普通外科杂志, 2017, 32(9): 807-812.
23. 冯琦琛, 李选, 李天润, 等. 合并 Cockett 综合征的急性下肢深静脉血栓形成患者髂静脉扩张成形时机对导管直接溶栓持续时间的影响. 中国微创外科杂志, 2013, 13(2): 116-118, 126.
24. 印于, 金泳海, 樊宝瑞, 等. 机械性血栓清除术联合同期髂静脉支架植入治疗合并左髂静脉受压综合征的急性下肢深静脉血栓形成. 中华介入放射学电子杂志, 2018, 6(1): 46-50.
25. Mickley V, Schwagierek R, Rilinger N, et al. Left iliac venous thrombosis caused by venous spur: treatment with thrombectomy and stent implantation. J Vasc Surg, 1998, 28(3): 492-497.
26. Oguzkurt L, Tercan F, Ozkan U, et al. Iliac vein compression syndrome: outcome of endovascular treatment with long-term follow-up. Eur J Radiol, 2008, 68(3): 487-492.
27. Ming ZB, Li WD, Yuan RF, et al. Effectiveness of catheter directed thrombolysis and stent implantation on iliofemoral vein thrombosis caused by iliac vein compression. J Thromb Thrombolysis, 2017, 44(2): 254-260.
28. 戈小虎, 唐加热克, 朱兵, 等. 髂静脉压迫综合征并下肢深静脉血栓的腔内治疗. 新疆医学, 2017, 47(1): 1-4, 19.
29. Mahnken AH, Thomson K, de Haan M, et al. CIRSE standards of practice guidelines on iliocaval stenting. Cardiovasc Intervent Radiol, 2014, 37(4): 889-897.
30. 李文东, 李晓强. 髂静脉支架进入下腔静脉长度的探讨. 中国血管外科杂志 (电子版), 2017, 9(4): 241-243.
31. Saha P, Black S, Breen K, et al. Contemporary management of acute and chronic deep venous thrombosis. Br Med Bull, 2016, 117(1): 107-120.
32. Wang WD, Zhao Y, CHenYX. Stenting for chronic obstructive venous disease: A current comprehensive meta-analysis and systematic review. Phlebology, 2016, 31(6): 376-389.
33. Vogel D, Comerota AJ, Al-Jabouri M, et al. Common femoral endovenectomy with iliocaval endoluminal recanalization improves symptoms and quality of life in patients with postthrombotic iliofemoral obstruction. J Vasc Surg, 2012, 55(1): 129-135.
34. Cho WP, Cho S, Cho MJ, et al. Femoral endovenectomy with iliac stenting for chronic iliofemoral venous occlusion. Vasc Specialist Int, 2017, 33(4): 166-169.
35. de Wolf MA, Jalaie H, van Laanen JH, et al. Endophlebectomy of the common femoral vein and arteriovenous fistula creation as adjuncts to venous stenting for post-thrombotic syndrome. Br J Surg, 2017, 104(6): 718-725.