• 中日友好醫(yī)院心臟血管外科(北京 100029);

目的  總結(jié)復(fù)合手術(shù)治療Cockett綜合征并發(fā)急性下肢深靜脈血栓形成(DVT)的治療經(jīng)驗(yàn)與臨床療效。
方法  2008年10月至2012年3月期間,我院對(duì)23例Cockett綜合征并發(fā)急性下肢DVT患者進(jìn)行經(jīng)股靜脈切開取栓聯(lián)合同側(cè)髂靜脈腔內(nèi)介入治療。男8例,女15例;年齡36~76歲,平均59.3歲。血栓累及左側(cè)髂股靜脈者21例,累及右側(cè)髂股靜脈者2例?;贾憩F(xiàn)為明顯腫脹、疼痛,術(shù)前經(jīng)血管超聲診斷明確髂股靜脈血栓形成。DVT發(fā)病時(shí)間平均為2.53d。所有手術(shù)采用全身麻醉,取栓前均先植入下腔靜脈濾器,取栓后經(jīng)同側(cè)股靜脈順行造影確診Cokket綜合征,對(duì)髂靜脈重度狹窄段介入治療,共置入28枚自膨式血管支架。
結(jié)果  23例病例手術(shù)成功率為100%,1例術(shù)后傷口出現(xiàn)血腫。術(shù)中出血量為150~750ml,平均300ml。隨訪時(shí)間為3~26個(gè)月,平均11.7個(gè)月,所有患者均未出現(xiàn)血栓復(fù)發(fā)。采用生活質(zhì)量調(diào)查問卷形式對(duì)患者進(jìn)行隨訪,21例患者治愈,臨床癥狀完全消失;2例患者好轉(zhuǎn),術(shù)后存留輕度下肢腫脹。
結(jié)論  復(fù)合手術(shù)治療Cockett綜合征合并急性DVT的方法安全、有效,早期臨床結(jié)果滿意,并發(fā)癥發(fā)生率低。

引用本文: 陳潔,葉志東,樊雪強(qiáng),劉鵬. 復(fù)合手術(shù)治療Cockett綜合征并發(fā)急性深靜脈血栓的臨床療效. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(11): 1175-1178. doi: 復(fù)制

1. Cockett FB, Thomas ML. The iliac compression syndrome[J]. Br J Surg, 1965, 52(10):816-821.
2. Kahn SR, Lamping DL, Ducruet T, et al. VEINES-QOL/Sym questionnaire was a reliable and valid disease-specific quality of life measure for deep venous thrombosis[J]. J Clin Epidemiol, 2006, 59(10):1049-1056.
3. Tuygun AK, Ketenci B, Günay R, et al. Validity and reliability of VEINES-QOL/Sym questionnaire in chronic venous disorders[J]. J Cardiovasc Surg (Torino), 2012, 53(3):355-361.
4. Akesson H, Brudin L, Dahlström JA, et al. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation[J]. Eur J Vasc Surg, 1990, 4(1):43-48.
5. Comerota AJ, Throm RC, Mathias SD, et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life[J]. J Vasc Surg, 2000, 32(1):130-137.
6. Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis:long-term effects on venous hemodynamics, clinical status, and quality of life[J]. Ann Surg, 2004, 239(1):118-126.
7. 趙軍, 董國祥. 左髂總靜脈狹窄與急性下肢深靜脈血栓形成[J]. 中華外科雜志, 1998, 36(1):12-14.
8. 張精勇, 金星, 吳學(xué)君, 等. 濾器保護(hù)下置管溶栓治療下肢深靜脈血栓形成臨床總結(jié)[J]. 中國實(shí)用外科雜志, 2006, 26(10):774-776.
9. Shebel ND, Whalen CC. Diagnosis and management of iliac vein compression syndrome[J]. J Vasc Nurs, 2005, 23(1):10-19.
10. Cho YP, Ahn JH, Choi SJ, et al. Endovascular management of iliofemoral deep venous thrombosis due to iliac vein compression syndrome in patients with protein C and/or S deficiency[J]. J Korean Med Sci, 2004, 19(5):729-734.
11. Berger A, Jaffe JW, York TN. Iliac compression syndrome treated with stent placement[J]. J Vasc Surg, 1995, 21(3):510-514.
12. Oguzkurt L, Tercan F, Ozkan U, et al. Iliac vein compression syndrome:outcome of endovascular treatment with long-term follow-up[J]. Eur J Radiol, 2008, 68(3):487-492.
13. Patel NH, Stookey KR, Ketcham DB, et al. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome[J]. J Vasc Interv Radiol, 2000, 11(10):1297-1302.
14. Raju S. Iliac vein outflow obstruction in ‘primary’ chronic venous disease[J]. Phlebolymphology, 2008, 15(1):12-16.
15. Raju S, Owen S Jr, Neglen P. The clinical impact of iliac venous stents in the management of chronic venous insufficiency[J]. J Vasc Surg, 2002, 35(1):8-15.
16. O’Sullivan GJ, Semba CP, Bittner CA, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome[J]. J Vasc Interv Radiol, 2000, 11(7):823-836.
17. Mussa FF, Peden EK, Zhou W, et al. Iliac vein stenting for chronic venous insufficiency[J]. Tex Heart Inst J, 2007, 34(1):60-66.
18. Forauer AR, Gemmete JJ, Dasika NL, et al. Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome[J]. J Vasc Interv Radiol, 2002, 13(5):523-527.
19. Neglén P, Raju S. Balloon dilation and stenting of chronic iliac vein obstruction:technical aspects and early clinical outcome[J]. J Endovasc Ther, 2000, 7(2):79-91.
20. Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein[J]. J Vasc Surg, 2002, 35(4):694-700.
21. Lumsden AB, Macdonald MJ, Isiklar H, et al. Central venous stenosis in the hemodialysis patient:incidence and efficacy of endovascular treatment[J]. Cardiovasc Surg, 1997, 5(5):504-509.
22. Neglén P, Tackett TP Jr, Raju S. Venous stenting across the inguinal ligament[J]. J Vasc Surg, 2008, 48(5):1255-1261.
  1. 1. Cockett FB, Thomas ML. The iliac compression syndrome[J]. Br J Surg, 1965, 52(10):816-821.
  2. 2. Kahn SR, Lamping DL, Ducruet T, et al. VEINES-QOL/Sym questionnaire was a reliable and valid disease-specific quality of life measure for deep venous thrombosis[J]. J Clin Epidemiol, 2006, 59(10):1049-1056.
  3. 3. Tuygun AK, Ketenci B, Günay R, et al. Validity and reliability of VEINES-QOL/Sym questionnaire in chronic venous disorders[J]. J Cardiovasc Surg (Torino), 2012, 53(3):355-361.
  4. 4. Akesson H, Brudin L, Dahlström JA, et al. Venous function assessed during a 5 year period after acute ilio-femoral venous thrombosis treated with anticoagulation[J]. Eur J Vasc Surg, 1990, 4(1):43-48.
  5. 5. Comerota AJ, Throm RC, Mathias SD, et al. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life[J]. J Vasc Surg, 2000, 32(1):130-137.
  6. 6. Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis:long-term effects on venous hemodynamics, clinical status, and quality of life[J]. Ann Surg, 2004, 239(1):118-126.
  7. 7. 趙軍, 董國祥. 左髂總靜脈狹窄與急性下肢深靜脈血栓形成[J]. 中華外科雜志, 1998, 36(1):12-14.
  8. 8. 張精勇, 金星, 吳學(xué)君, 等. 濾器保護(hù)下置管溶栓治療下肢深靜脈血栓形成臨床總結(jié)[J]. 中國實(shí)用外科雜志, 2006, 26(10):774-776.
  9. 9. Shebel ND, Whalen CC. Diagnosis and management of iliac vein compression syndrome[J]. J Vasc Nurs, 2005, 23(1):10-19.
  10. 10. Cho YP, Ahn JH, Choi SJ, et al. Endovascular management of iliofemoral deep venous thrombosis due to iliac vein compression syndrome in patients with protein C and/or S deficiency[J]. J Korean Med Sci, 2004, 19(5):729-734.
  11. 11. Berger A, Jaffe JW, York TN. Iliac compression syndrome treated with stent placement[J]. J Vasc Surg, 1995, 21(3):510-514.
  12. 12. Oguzkurt L, Tercan F, Ozkan U, et al. Iliac vein compression syndrome:outcome of endovascular treatment with long-term follow-up[J]. Eur J Radiol, 2008, 68(3):487-492.
  13. 13. Patel NH, Stookey KR, Ketcham DB, et al. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome[J]. J Vasc Interv Radiol, 2000, 11(10):1297-1302.
  14. 14. Raju S. Iliac vein outflow obstruction in ‘primary’ chronic venous disease[J]. Phlebolymphology, 2008, 15(1):12-16.
  15. 15. Raju S, Owen S Jr, Neglen P. The clinical impact of iliac venous stents in the management of chronic venous insufficiency[J]. J Vasc Surg, 2002, 35(1):8-15.
  16. 16. O’Sullivan GJ, Semba CP, Bittner CA, et al. Endovascular management of iliac vein compression (May-Thurner) syndrome[J]. J Vasc Interv Radiol, 2000, 11(7):823-836.
  17. 17. Mussa FF, Peden EK, Zhou W, et al. Iliac vein stenting for chronic venous insufficiency[J]. Tex Heart Inst J, 2007, 34(1):60-66.
  18. 18. Forauer AR, Gemmete JJ, Dasika NL, et al. Intravascular ultrasound in the diagnosis and treatment of iliac vein compression (May-Thurner) syndrome[J]. J Vasc Interv Radiol, 2002, 13(5):523-527.
  19. 19. Neglén P, Raju S. Balloon dilation and stenting of chronic iliac vein obstruction:technical aspects and early clinical outcome[J]. J Endovasc Ther, 2000, 7(2):79-91.
  20. 20. Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein[J]. J Vasc Surg, 2002, 35(4):694-700.
  21. 21. Lumsden AB, Macdonald MJ, Isiklar H, et al. Central venous stenosis in the hemodialysis patient:incidence and efficacy of endovascular treatment[J]. Cardiovasc Surg, 1997, 5(5):504-509.
  22. 22. Neglén P, Tackett TP Jr, Raju S. Venous stenting across the inguinal ligament[J]. J Vasc Surg, 2008, 48(5):1255-1261.