Diagnosis and Treatment of Deep Venous Thrombosis of Lower Limb_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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马玉奎 , 赵纪春 , 胡志 , 黄斌

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Keywords：

深静脉血栓形成; 诊断; 　治疗

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目的总结我科2002年3月至2005年10月收治的下肢深静脉血栓形成(deep vein thrombosis,DVT)患者的诊治经验.方法本组下肢DVT患者275例,患肢294条.男134例,女141例,年龄14～92岁,平均(50.76±16.43)岁.单侧下肢DVT 256例(左侧159例,右侧97例),19例为双下肢DVT(其中有8例是仅一侧肢体有临床表现); 属混合型194条,中央型74条,周围型26条.行彩色多普勒或静脉造影检查了解血栓部位及范围; 对怀疑有肺动脉栓塞(pulmonary embolism, PE)者行肺部增强CT扫描.治疗包括抗凝、溶栓、祛聚、梯度压力静脉弹力袜以及对症处理.对反复发生PE、存在抗凝治疗禁忌证、需要手术取栓、下肢静脉存在悬浮游离血栓者安置下腔静脉滤器.对发生股青肿患者行手术取栓.疗效评价: 住院期间观察症状变化,监测膝关节上、下15 cm处周径; 对随访患者行CEAP(clinical-etiology-anatomic-pathophysiologic)临床表现分级、功能障碍评分(venous disability score, VDS).结果本组DVT常见的危险因素包括活动受限史、2周以内有手术史、恶性肿瘤及外伤史.本组患肢主要临床表现包括: 肿胀、疼痛、皮温增高、皮肤暗红、浅静脉迂曲等.并发症: PE 9例,股青肿2例,下腔静脉阻塞综合征3例.275例中2例行手术取栓,25例安置下腔静脉滤器.本组患者症状经治疗后1～5 d开始缓解,出院时膝关节上、下周径较入院时明显缩小(P＜0.05).随访时间6个月～3年,195例(70.9%)的201条(68.4%)患肢获得随访,患肢CEAP分级: C0级78条,C1级53条,C2级16条,C3级20条,C4级15条,C5级11条,C6级8条; VDS评分: 0分77例,1分66例,2分33例,3分19例.结论下肢DVT的诊断中应注意对危险因素以及无症状的DVT的搜寻; 早期治疗以非手术治疗为主,通过抗凝、溶栓等综合治疗可以达到满意效果; 在早期如发生股青肿应及时手术治疗; 有选择地安置下腔静脉滤器可防止PE的发生; 后期应根据病情特点确定治疗方案和疗程.

Citation： 马玉奎,赵纪春,胡志,黄斌. Diagnosis and Treatment of Deep Venous Thrombosis of Lower Limb. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(1): 56-58. doi: Copy

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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,霍正禄,周彬,等.483例静脉血栓栓塞症临床资料分析[J].中国急救医学,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. 邓劼,蒋米尔.深静脉血栓形成的影像学诊断[J].中国实用外科杂志,2005; 25(4)∶243.
7. 景在平,赵珺.深静脉血栓形成的诊断方法[J].中国实用外科杂志,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. 李晓强,桑宏飞.下肢深静脉血栓形成的外科治疗[J].中国普外基础与临床杂志,2006; 13(6)∶638.
10. 陈鸿强,李光新,许崇恩,等.急性下肢深静脉血栓形成的溶栓治疗分析(附126例报告)[J].中国普外基础与临床杂志,2006; 13(6)∶665.
11. 武欣,俞恒锡,张建,等.下腔静脉滤器在深静脉血栓治疗中的应用[J].河北医科大学学报,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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment of Deep Venous Thrombosis of Lower Limb

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