下肢深静脉血栓形成手术时机探析.doc

下肢深静脉血栓形成手术时机探析 　【摘要】目的：探讨下肢深静脉血栓形成（LEDVT）手术时机的选择。方法：LEDVT 47例，按照临床病程分为早期组（≤3d）23例和中期组（≤10d）18例、晚期组（＞10d）6例。所有病例均采用股静脉切开取栓术。结果：早中期组术后恢复良好，早期组术后患肢肿胀2d以内明显消退；中期组术后患肢肿胀于5d内消退占10/18；晚期患者术后患肢肿胀消退缓慢，术后5d仍有肿胀占5/6。早中期患者术后血栓病理多为新鲜血栓，晚期多为陈旧血栓。结论：下肢深静脉血栓形成的患者在10d内应积极手术取栓治疗，10d以上不宜手术而以保守治疗为主。 【关键词】深静脉血栓形成#12539;腿#12539;外科手术 The opportunity choice of surgical procedure for deep venous thrombosis of lower extremity 【ABSTRACT】Objective:To study the choices of times for surgical procedure for lower extremity deep vein thrombosis(LEDVT).Methods:We retrospectively analyzed 47 patients who received surgical therapy for their LEDVT in our hospital during 3 years.According to the time from they had this disease to obtaining therapy,all of the patients were divided into three stages:early stage:23 patients,≤3 days;middle stage:18 patients 4~10 days;later stage:6 patients;＞10 days.All the patients received operations.Results:The prognoses of 80.49% patients in the early and middle stages were well ,the fadeaway of edema was evident,on the contrary,the prognoses of 83.33% patients of the later stage were worse,the fadeaway of edema was slow.Conclusion:The patients of LEDVT should receive operation as early as possibly in 10 days,the patients should receive conservative therapy after 10 days. 【KEY WORDS】Venous thrombosis#12539;Leg#12539;Surgical procedure,operative 深静脉血栓形成（deep venous thrombosis,DVT）多见于下肢，目前临床工作对于下肢深静脉血栓手术取栓的时机存在较大分歧，故我们对近3年来我院手术治疗的47例患者进行了回顾性分析，探讨合理、科学的手术时机。 1 资料和方法 1.1 临床资料 2001~2004年我院手术治疗的下肢DVT 47例，根据临床病程，将其分为早期组、中期组和晚期组。早期组（≤3d）、23例，中期组（4~10d），18例，晚期组（＞10d），6例。90%的患者发生于左下肢，临床表现为下肢肿胀、疼痛，浅表静脉曲张，患肢皮温可有升高，严重时可有足背动脉搏动减弱，皮温降低；血管彩超示广泛深浅或深静脉血栓形成，回流血量减少或消失。术后所有标本均送病理证实为新鲜或陈旧血栓，偶有血栓机化。 1.2 手术方法 3组均采取相同的手术方法取栓。依次切开皮肤、皮下组织，显露大隐静脉，在不妨碍手术视野的前提下尽量保护大隐静脉及其属支；找到股静脉后，在大隐静脉汇点的上方或下方解剖出长约3~4cm的股静脉，两端上阻断带。经静脉注入肝素钠使全身达半肝素化后，切开股静脉壁取出切口附近的血栓，然后用Fogarty取栓管首先向近心端反复取栓，然后远端肢体首选挤压法，再配合应用取栓管，至有血液涌处提示血管通畅，然后用取栓管向远端注入尿激酶溶残余的小栓子；用无创缝合线缝合静脉壁，置引流管一根接引流袋。术后所有标本均送病理。术后应用抗凝祛聚等药物治疗。 　 2 结 果 每组患者比较健侧患