北京大学学报(医学版) ›› 2024, Vol. 56 ›› Issue (2): 322-325. doi: 10.19723/j.issn.1671-167X.2024.02.019

• 论著 • 上一篇    下一篇

经同侧大隐静脉入路髂静脉成型及支架植入术在日间治疗模式中的应用

冯琦琛*(),盖铄,王昌明,李选   

  1. 北京大学第三医院介入血管外科, 北京 100191
  • 收稿日期:2022-11-22 出版日期:2024-04-18 发布日期:2024-04-10
  • 通讯作者: 冯琦琛 E-mail:fengqichen2013@126.com

Application of iliac vein molding and stent implantation through the ipsilateral great saphenous vein approach in daytime treatment mode

Qichen FENG*(),Shuo GAI,Changming WANG,Xuan LI   

  1. Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-11-22 Online:2024-04-18 Published:2024-04-10
  • Contact: Qichen FENG E-mail:fengqichen2013@126.com

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摘要:

目的: 探讨髂静脉狭窄患者经同侧大隐静脉入路髂静脉成型及支架植入术在日间治疗模式中应用的可行性和近期疗效。方法: 回顾性分析2017年2月至2022年3月经同侧大隐静脉入路实施髂静脉成型及支架植入术日间模式治疗的病例,共21例,男6例,女15例,年龄37~79岁[(62.5±10.2)岁]。髂静脉狭窄中单纯累及髂总静脉16例,单纯累及髂外静脉2例,同时累及髂总及髂外静脉3例,均通过同侧大隐静脉入路行髂静脉成型及髂静脉支架植入术,同时存在大隐静脉瓣膜功能不全的单纯髂静脉狭窄患者同期行大隐静脉射频闭合及曲张静脉硬化治疗术。术后规律直接口服抗凝药治疗及压力治疗,所有患者住院时间均于小于24 h。结果: 所有21例患者手术均成功(手术成功率100%),术中无并发症,术后即刻并发症中穿刺点出血1例,加压包扎纱布被完全浸湿,经再次压迫止血5 min后渗血停止,所有患者住院时间均于小于24 h。随访结果:术后3个月随访率100%,其中绝对有效18例(18/21,85.7%),相对有效(术后仍有色素沉着,但范围减小)3例(3/21,14.3%)。髂静脉支架均通畅,同期行大隐静脉射频治疗患者射频治疗段大隐静脉主干均闭合良好。术后6个月随访率71.4%(15/21),其中绝对有效14例(14/15,93.3%),相对有效(术后仍有色素沉着,但范围减小)1例(1/15,6.7%)。髂静脉支架均通畅,同期行大隐静脉射频治疗患者射频治疗段大隐静脉主干均闭合良好。结论: 经大隐静脉入路髂静脉狭窄的介入治疗技术在日间治疗模式中可行,有明确优势,近期疗效满意。

关键词: 大隐静脉, 髂静脉狭窄, 日间治疗模式

Abstract:

Objective: To explore the feasibility and recent efficacy of iliac vein molding and stenting in daytime treatment mode in patients with iliac vein stenosis. Methods: Medical records of iliac vein molding and stenting performed in the ipsilateral great saphenous vein approach conducted from February 2017 to March 2022 were retrospective reviewed. There were 21 cases, 6 males and 15 females. Age ranged from 37 to 79 years [(62.5 ± 10.2) years]. The stenosis in the 21 limbs simply involved the common iliac veins in 16 patients, 2 patients had the simple and external iliac veins, and both the total and external iliac veins in 3 patients. Both iliac vein molding and iliac vein stenting were performed through the ipsilateral great saphenous vein approach. The patients with simple iliac vein stenosis with great saphenous vein valve insufficiency also underwent radiofrequency closure of great saphenous vein and flexural vein sclerosis therapy simultaneously. Regular postoperative direct oral anticoagulants therapy and stress therapy were followed. All the patients were hospitalized for less than 24 h. Results: All the 21 patients operations were successful (the success rate was 100%), without any intraoperative complications. Immediate postoperative complications were puncture point bleeding in 1 case. The bandage gauze was completely wet. The bleeding was stopped after 5min of recompression. All the patients were hospitalized for less than 24 h. Follow-up results: The 3-month follow-up rate after operation was 100%. Absolute effective 18 cases (18/21, 85.7%). Relatively effective(postmentation still after surgery, but with less extent) in 3 cases (3/21, 14.3%). The iliac vein stents were unobstructed, and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treatment. The 6-month follow-up rate after operation was 71.4%(15/21). Of these, 14 cases (14/15, 93.3%) were absolutely effective. Relatively effective(postmentation still after surgery, but with less extent) in 1 case (1/15, 6.7%). The iliac vein stents were no restenosis or obstruction, and the trunk of the great saphenous vein was well closed in the patients with great saphenous vein radiofrequency treatment. Conclusion: The interventional treatment technique of iliac vein stenosis is feasible in the daytime treatment mode, with clear advantages and satisfactory recent efficacy.

Key words: Great saphenous vein, Iliac vein stenosis, Daytime treatment mode

中图分类号: 

  • R654.4
1 Coekett FB , Thomas ML . The iliac compression syndrome[J]. Br J Surg, 1965, 52, 816- 821.
2 Bomalaski MD , Mills JL , Argueso LR , et al. lliac vein compression syndrome: An unusual cause of varicocele[J]. J Vasc Surg, 1993, 18, 1064- 1068.
doi: 10.1016/0741-5214(93)90564-3
3 赵军, 董国祥. 左髂总静脉狭窄与急性下肢深静脉血栓形成[J]. 中华外科杂志, 1998, 36 (1): 12- 14.
4 冯琦琛, 王昌明, 李选, 等. 超声引导下腔内射频闭合术联合局部点剥治疗下肢静脉曲张[J]. 中国微创外科杂志, 2018, 18 (7): 577- 580.
5 Wang CM , Zhang WL , Li X . C-arm-based flat-panel detector cone-beam computed tomography venography in the diagnosis of iliac vein compression syndrome[J]. Chin Med J (Engl), 2020, 134 (4): 431- 438.
6 Budnur SC , Singh B , Mahadevappa NC , et al. Endovascular treatment of iliac vein compression syndrome (May-Thurner)[J]. Cardiovasc Interv Ther, 2013, 28 (1): 101- 105.
doi: 10.1007/s12928-012-0122-3
7 孙洋, 徐一丁, 张杰, 等. 同期或分期腔内治疗May-Thurner综合征伴左下肢静脉曲张效果比较[J]. 介入放射学杂志, 2020, 29 (2): 186- 190.
8 李晓强, 桑宏飞, 戎建杰, 等. 介入治疗髂静脉狭窄或闭塞的远期效果观察[J]. 中国血管外科杂志(电子版), 2010, 2 (1): 20- 23.
9 李荣宾, 蔡旭东. 腔内一站式治疗左髂静脉狭窄合并大隐静脉曲张63例近期疗效分析[J]. 福建医药杂志, 2017, 39 (4): 21- 24.
10 Stuck AK , Kunz S , Baumgartner I , et al. Patency and clinical outcomes of a dedicated, self-expanding, hybrid oblique stent used in the treatment of common iliac vein compression[J]. J Endovasc Ther, 2017, 24 (1): 159- 166.
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