目的 總結(jié)我科2002年3月至2005年10月收治的下肢深靜脈血栓形成(deep vein thrombosis,DVT)患者的診治經(jīng)驗.方法 本組下肢DVT患者275例,患肢294條.男134例,女141例,年齡14～92歲,平均(50.76±16.43)歲.單側(cè)下肢DVT 256例(左側(cè)159例,右側(cè)97例),19例為雙下肢DVT(其中有8例是僅一側(cè)肢體有臨床表現(xiàn)); 屬混合型194條,中央型74條,周圍型26條.行彩色多普勒或靜脈造影檢查了解血栓部位及范圍; 對懷疑有肺動脈栓塞(pulmonary embolism, PE)者行肺部增強CT掃描.治療包括抗凝、溶栓、祛聚、梯度壓力靜脈彈力襪以及對癥處理.對反復(fù)發(fā)生PE、存在抗凝治療禁忌證、需要手術(shù)取栓、下肢靜脈存在懸浮游離血栓者安置下腔靜脈濾器.對發(fā)生股青腫患者行手術(shù)取栓.療效評價: 住院期間觀察癥狀變化,監(jiān)測膝關(guān)節(jié)上、下15 cm處周徑; 對隨訪患者行CEAP(clinical-etiology-anatomic-pathophysiologic)臨床表現(xiàn)分級、功能障礙評分(venous disability score, VDS).結(jié)果 本組DVT常見的危險因素包括活動受限史、2周以內(nèi)有手術(shù)史、惡性腫瘤及外傷史.本組患肢主要臨床表現(xiàn)包括: 腫脹、疼痛、皮溫增高、皮膚暗紅、淺靜脈迂曲等.并發(fā)癥: PE 9例,股青腫2例,下腔靜脈阻塞綜合征3例.275例中2例行手術(shù)取栓,25例安置下腔靜脈濾器.本組患者癥狀經(jīng)治療后1～5 d開始緩解,出院時膝關(guān)節(jié)上、下周徑較入院時明顯縮小(P＜0.05).隨訪時間6個月～3年,195例(70.9%)的201條(68.4%)患肢獲得隨訪,患肢CEAP分級: C0級78條,C1級53條,C2級16條,C3級20條,C4級15條,C5級11條,C6級8條; VDS評分: 0分77例,1分66例,2分33例,3分19例.結(jié)論 下肢DVT的診斷中應(yīng)注意對危險因素以及無癥狀的DVT的搜尋; 早期治療以非手術(shù)治療為主,通過抗凝、溶栓等綜合治療可以達到滿意效果; 在早期如發(fā)生股青腫應(yīng)及時手術(shù)治療; 有選擇地安置下腔靜脈濾器可防止PE的發(fā)生; 后期應(yīng)根據(jù)病情特點確定治療方案和療程.
引用本文： 馬玉奎,趙紀春,胡志,黃斌. 下肢深靜脈血栓形成的診斷及綜合治療. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(1): 56-58. doi: 復(fù)制
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- 1. Robert B Rutherford Eds.Rutherford vascular surgery[M].1st ed.Beijing:People’s Medical Publishing House,2002∶1990-1999.
- 2. 王美堂,霍正祿,周彬,等.483例靜脈血栓栓塞癥臨床資料分析[J].中國急救醫(yī)學(xué),2005; 25(5)∶330.
- 3. Geerts WH,Pineo GF,Heit JA,et al.Prevention of venous thromboembolism:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy[J].Chest,2004; 126(3 Suppl)∶338S.
- 4. Wells PS,Hirsh J,Anderson DR,et al.A simple clinical model for the diagnosis of deep-vein thrombosis combined with impedance plethysmography:potential for an improvement in the diagnostic process[J].J Intern Med,1998; 243(1)∶15.
- 5. Garcia ND,Morasch MD,Ebaugh JL,et al.Is bilateral ultrasound scanning of the legs necessary for patients with unilateral symptoms of deep vein thrombosis?[J].J Vasc Surg,2001; 34(5)∶792.
- 6. 鄧劼,蔣米爾.深靜脈血栓形成的影像學(xué)診斷[J].中國實用外科雜志,2005; 25(4)∶243.
- 7. 景在平,趙珺.深靜脈血栓形成的診斷方法[J].中國實用外科雜志,2003; 23(4)∶196.
- 8. Büller HR,Agnelli G,Hull RD,et al.Antithrombotic therapy for venous thromboembolic disease:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy[J].Chest,2004; 126(3 Suppl)∶401S.
- 9. 李曉強,桑宏飛.下肢深靜脈血栓形成的外科治療[J].中國普外基礎(chǔ)與臨床雜志,2006; 13(6)∶638.
- 10. 陳鴻強,李光新,許崇恩,等.急性下肢深靜脈血栓形成的溶栓治療分析(附126例報告)[J].中國普外基礎(chǔ)與臨床雜志,2006; 13(6)∶665.
- 11. 武欣,俞恒錫,張建,等.下腔靜脈濾器在深靜脈血栓治療中的應(yīng)用[J].河北醫(yī)科大學(xué)學(xué)報,2005; 26(2)∶97.
- 12. Journeycake JM,Quinn CT,Miller KL,et al.Catheter-related deep venous thrombosis in children with hemophilia[J].Blood,2001; 98(6)∶1727.