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中华血管外科杂志
中华血管外科杂志

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中华血管外科杂志/Journal Chinese Journal of Vascular Surgery
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    “静脉血栓栓塞症”的认知变迁和现代治疗理念

    陈忠杨耀国王丽萍
    159-166页
    查看更多>>摘要：人类对于静脉血栓栓塞症（VTE）的科学认识和探索至今已有一百多年，对于疾病的认知变迁推动了治疗手段的发展。深入探索静脉血栓形成机制引导了抗凝溶栓药物的推陈出新，同时医疗技术的进步使得腔内技术治疗VTE成为可能。VTE治疗理念也随着治疗手段的多样化而不断更新，对治疗效果和安全性都提出了更高的要求。本文将跟随VTE治疗手段的变迁梳理各种治疗方式在现代VTE治疗理念中的角色和作用，并简述对于髂静脉压迫综合征和肺血栓栓塞两类特殊VTE疾病的治疗理念。 The scientific understanding and exploration of venous thromboembolism (VTE) have continued since more than a hundred years ago, and the cognitive changes in diseases have promoted the development of treatment methods. In-depth exploration of the mechanism of venous thrombosis has led to the introduction of anticoagulant and thrombolytic drugs. The advancement of medical technology has made it possible to treat VTE with endovascular technology. The concepts of VTE treatment are also constantly updated with the diversification of treatment methods, which puts forward higher requirements for treatment effect and safety. This article will follow the changes in VTE treatment methods to clarify the role and fundation of each treatment method in the current VTE treatment concepts, and briefly describe the treatment concepts for two special VTE diseases, iliac venous compression syndrome and pulmonary thromboembolism.

    静脉血栓栓塞症肺栓塞髂静脉压迫综合征治疗理念

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    重视开展下肢深静脉血栓形成后综合征腔内治疗的研究

    王深明汪睿王丽萍
    167-169页
    查看更多>>摘要：深静脉血栓后综合征（PTS）是下肢深静脉血栓形成后的远期并发症之一。近年来静脉腔内治疗已成为治疗PTS的重要方式，但因该治疗方式的效果目前尚缺乏高质量循证医学证据及现有静脉支架在很多方面尚不成熟，PTS的腔内治疗仍存在一些问题与争议。本文就PTS的诊断及腔内治疗适应证进行探讨，同时结合目前国际上最新文献讨论PTS腔内治疗的短期临床效果与远期通畅结果，并对PTS腔内治疗的未来进行展望。 Post-thrombotic syndrome (PTS) is one of the long-term complications of lower extremity deep venous thrombosis. In recent years, endovascular treatment has become an important method for treating PTS. However, because this method currently has not yet achieved a high level of evidence-based medicine and the existing venous stents are not yet mature in many aspects, there are still some problems and controversies regarding the endovascular treatment of PTS. This article discusses the diagnosis and endovascular treatment indications of PTS while combining the latest literature to discuss the short-term clinical effects and long-term patency of endovascular treatment, and forecasting the future of endovascular treatment for PTS.

    深静脉血栓形成血栓形成后综合征腔内治疗

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    下肢深静脉血栓清除的现状与进展

    史振宇符伟国王丽萍
    170-174页
    查看更多>>摘要：随着临床经验的积累以及腔内治疗技术的逐步发展，越来越多的急性深静脉血栓形成（DVT）开展了血栓清除治疗。血栓清除治疗主要包括置管溶栓和机械血栓清除，有助于短期内减轻症状，长期降低血栓后综合征的发生，适用于急性和亚急性的中央型以及全肢型下肢DVT。本文将对近年来静脉血栓清除技术的发展、现状、策略以及进展进行简要介绍，为临床实践提供参考。 With the accumulation of clinical experiences and the development of endovascular treatment technique, more acute deep vein thrombosis (DVT) underwent thrombus removal. Thrombus removal includes catheter-directed thrombolysis and percutaneous mechanical thrombectomy. It applies to treat acute, subacute, central type and entire limb DVT and helps to alleviate swelling symptoms in the short term and decrease post-thrombotic syndrome in the long term. This paper will give a brief introduction of the development, status and perspective of thrombus removal techniques to provide reference to clinical practice.

    深静脉血栓形成置管溶栓机械血栓清除

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    纵览新型口服抗凝药物

    张福先王丽萍
    175-177页
    查看更多>>摘要：第三代新型口服抗凝药物（NOAC）的代表Ⅹa因子抑制剂（利伐沙班）和Ⅱa因子抑制剂（达比加群）在中国临床应用已有多年。与第一代抗凝药物大分子肝素和第二代低分子肝素相比，NOAC作为单靶点和直接的凝血因子抑制剂，在有效抗凝和减少并发症发生方面具有明显优势。但是NOAC完美吗？回答是否定的。NOAC在临床应用中还是存在一些不确定性和挑战，本文就相应问题进行论述。 Factor Xa inhibitors Rivaroxaban and factor IIa inhibitor Dabigatran, representative of the third-generation of novel oral anticoagulants (NOACs), have been used clinically in China for many years. Compared to first-generation high molecular weight heparin and second- generation low molecular weight heparin, as a single-target, direct blood coagulation factor inhibitor has obvious advantages in effective anticoagulation and reducing adverse complications. However, are NOACs perfect? The answer is no. There are still some uncertainties and challenges in the clinical application of NOACs. This paper discusses the corresponding problems as follows.

    新型口服抗凝药物肝素低分子肝素

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    “静脉血栓栓塞症”单中心真实世界临床诊疗实践分析研究

    陈兵朱永斌何源潘以锋...
    178-182页
    查看更多>>摘要：静脉血栓栓塞症（VTE）是临床发病率较高的疾病和合并症，是造成低风险死亡事件和医疗纠纷的重要因素。近年来，在国家卫生健康委员会和有关部门推动下，建立了积极的VTE风险评估、预防策略和指南，取得了非常好的成绩。然而仍然缺乏大规模VTE发病率调查数据，而不同层级医院、科室对于VTE的整体评估、预防、治疗差异较大。本文就单中心两年的官方数据进行收集整理，对VTE的发病率和真实世界抗凝药物应用进行分析总结，为本领域进一步发展提供基础数据。 Venous thromboembolism (VTE) is a disease and complication with high clinical incidence, an important factor causing low-risk death events and medical disputes. In recent years, promoted by the National Health Commission and relevant departments, positive risk assessment and prevention strategies and guidelines for VTE have been established, and good results have been achieved. However, we still lack large-scale survey data on the incidence of venous thrombosis, and the overall assessment, prevention and treatment of VTE vary greatly among different levels of hospitals and departments. This paper collects the official data in our single center for two years, analyzes and summarizes the incidence of VTE and the application of anticoagulant drugs in the real world, and provides basic data for the further development of this field.

    静脉血栓栓塞症肺动脉栓塞静脉血栓栓塞症风险评估抗凝治疗

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    欧洲血管外科学会静脉血栓指南的更新与解读

    史振宇吴丹明王丽萍
    183-186页
    查看更多>>摘要：静脉血栓是常见的血管疾病，会导致肺栓塞以及血栓后综合征一系列严重并发症，为此国内外一直非常重视静脉血栓的诊治。2021版欧洲血管外科静脉血栓管理指南是目前最新的有关静脉血栓的诊治指南，其基于最新的循证医学证据提供了静脉血栓的各种诊断方法、各类治疗方法如抗凝治疗、压力治疗、血栓清除治疗等等的推荐，同时还涵盖了一些少见部位、特殊人群静脉血栓的诊治推荐。本文将对其中一些重点内容进行了介绍和解读，希望对临床静脉血栓实践提供参考和指导。 Venous thrombosis is a common vascular disease, which can lead to severe complication such as pulmonary embolism and post-thrombotic syndrome. So both domestic and overseas academy emphasize the diagnosis and treatment of venous thrombosis. "European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis" is the latest guideline which provide recommendation about the diagnosis, anticoagulation, compression therapy and thrombus removal of venous thrombosis based on the latest evidences. Besides, it also included the diagnosis and treatment of infrequent location and special population. This paper will introduce and explain some important contents of the guideline in order to provide reference to our clinical practice of venous thrombosis management.

    欧洲血管外科学会静脉血栓指南

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    一站式腔内治疗急性深静脉血栓形成合并髂静脉压迫综合征的临床价值

    何楠唐小斌梁紫轲张腾飞...
    187-192页
    查看更多>>摘要：目的 探索一站式腔内治疗急性深静脉血栓形成（DVT）合并髂静脉压迫综合征（IVCS）的临床价值。 方法 回顾性分析2018年1月至2022年10月北京安贞医院血管外科治疗左侧DVT合并IVCS的35例患者的临床资料。采取一站式腔内治疗的方法，观察术后疗效及并发症情况。采用t检验比较手术前后的患肢周径和相关实验室指标。 结果 35例患者均成功完成一站式腔内治疗，手术成功率100%。患肢治疗后静脉通畅度评分［（1.6±0.7）分 比（10.9±2.8）分，t=9.400，P<0.01］、患肢膝上及膝下周径差［（1.8±0.5）cm 比（6.3±0.8）cm，t=34.908，P<0.01；（1.6±0.2）cm 比（4.6±0.7）cm，t=11.188，P<0.01］均较治疗前减小，差异均有统计学意义。患者治疗后血红蛋白、D-二聚体水平较治疗前降低，差异有统计学意义［（9.9±1.0）g/L 比（12.0±0.7）g/L，t=4.795，P<0.01；（1 257.3±276.7）ng/ml 比（4 652.3±1 850.7）ng/ml，t=6.073，P<0.01］；肌酐水平与治疗前比较，差异无统计学意义（P=0.836）。35例患者均获得随访，随访时间为（31.7±16.4）个月（范围：6~63个月）。随访期内，3例患者出现行走后轻度疼痛，2例出现久站后沉重感（Villalta评分均<5分），且彩超结果提示患肢静脉通畅，无血栓形成后综合征发生。 结论 一站式腔内治疗急性DVT合并IVCS可以安全、有效地清除血栓、恢复管腔以及预防静脉血栓后综合征。 Objective To explore the clinical value of one-stop endovascular treatment for acute deep vein thrombosis (DVT) combined with iliac vein compression syndrome (IVCS). Methods The clinical data of 35 patients treated for left DVT combined with IVCS at the Department of Vascular Surgery, Beijing Anzhen Hospital, from January 2018 to Dctober 2022 were retrospectively analyzed. One-stop endovascular treatment was conducted and postoperative efficacy and complications were observed. T-test was used to compare the circumference of affected limbs and related laboratory indicators before and after surgery. Results All 35 patients completed one-stop endovascular treatment with a 100% of surgical success rate. After treatment, the venous patency score[1.6±0.7 vs 10.9±2.8, t=9.400, P<0.01], circumference difference in the upper and lower knees of affected limbs[(1.8±0.5)cmvs (6.3±0.8)cm, t=34.908, P<0.01 (1.6±0.2)cmvs (4.6±0.7)cm, t=11.188, P<0.01], and the patient's hemoglobin [(9.9±1.0) g/Lvs (12.0±0.7) g/L, t=4.795, P<0.01] and D-dimer [(1 257.3±276.7) ng/mlvs (4 652.3±1 850.7) ng/ml, t=6.073, P<0.01] were lower than before treatment. The differences were statistically significant. The creatinine level did not change significantly compared with before treatment (P=0.836). Thirty-five patients completed the (31.7±16.4) month (range:6-63 months) follow-up, 3 patients experienced mild pain after walking, and 2 patients experienced heaviness after a long standing (all Villalta scores<5). The color ultrasound results suggested that the veins of the affected limb were unobstructed, and no post-thrombotic syndrome (PTS) occurred in the follow-up patients. Conclusions One-stop endovascular treatment for acute DVT with IVCS is safe and effective in removing thrombus, restoring the lumen, and preventing PTS.

    深静脉血栓形成髂静脉压迫综合征腔内治疗,一站式疗效

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    顺行与逆行入路治疗急性下肢深静脉血栓形成的单中心短期疗效比较

    田轩刘建龙李金勇张蕴鑫...
    193-199页
    查看更多>>摘要：目的 对比顺行与逆行入路AngioJet血栓清除装置治疗急性下肢深静脉血栓形成（DVT）的疗效，探讨置入下腔静脉滤器的必要性。 方法 回顾性分析2020年1月至2021年12月北京积水潭医院血管外科66例（69条肢体）使用AngioJet治疗的急性下肢DVT患者的临床资料。按照操作与瓣膜开放方向不同分为顺行治疗和逆行治疗两组，评估两种治疗方法的滤器血栓拦截率、肺栓塞发生率、血栓清除效果、静脉阻塞率和血栓复发率。 结果 66例患者中，滤器血栓拦截率为37.9%（25/66），新发肺栓塞或肺栓塞加重发生率为3.0%（2/66），总体滤器取出率为95.5%（63/66）。顺行治疗组41例，其中血栓Ⅲ级清除15例，Ⅱ级清除25例，Ⅰ级清除1例，3个月静脉阻塞和血栓复发率为4.9%（2/41）；逆行治疗组28例，其中血栓Ⅲ级清除11例，Ⅱ级清除14例，Ⅰ级清除3例，3个月静脉阻塞和血栓复发率为7.1%（2/28）。 结论 顺行与逆行入路治疗下肢DVT均安全有效，短期深静脉通畅率良好，逆行操作血栓清除亦可获得良好的疗效；急性下肢DVT使用AngioJet血栓清除治疗时血栓脱落风险较高，建议放置腔静脉滤器进行有效拦截。 Objective To compare the efficacy of performing antegrade and retrograde approaches with the thrombectomy device, AngioJet, for the treatment of acute lower limb deep vein thrombosis (DVT) and explore the necessity of placement of filters. Methods Clinical data of 66 patients with acute lower limb DVT (69 limbs) treated with the AngioJet in the vascular surgery department of Beijing Ji-Shui-Tan Hospital from January 2020 to December 2021 were analyzed retrospectively. The patients were divided into two groups (antegrade treatment group and retrograde treatment group) according to the different operations and directions of valve opening. The thrombosis interception rate of the filter, incidence of pulmonary embolism (PE), effectiveness of thrombectomy, venous obstruction rate, and thrombosis recurrence rate of the two treatments were evaluated. Results The thrombosis interception rate of the filter was 37.9% (25/66), the incidence of new PE or PE exacerbation was 3.0% (2/66), and the overall filter retrieval rate was 95.5% (63/66). In the antegrade treatment group (n=41), thrombus removal of grade III occurred in 15 cases, grade II 25 cases, and grade I 1 case. Venous obstruction and thrombus recurrence rate 3 months after the surgery was 4.9% (2/41). In the retrograde treatment group (n=28), thrombus removal of grade III occurred in 11 cases, grade II 14 cases, and grade I 3cases. Venous obstruction and thrombosis recurrence rate 3 months after the surgery was 7.1% (2/28). Conclusion Both the antegrade and retrograde approaches are safe and effective in the treatment of lower limb DVT, with good short-term deep vein patency rates and good results with retrograde thrombectomy acute lower limb DVT is at high risk of thrombus shedding when treated with AngioJet thrombectomy, and the placement of a vena cava filter is recommended for effective interception.

    下肢深静脉血栓形成经皮机械血栓清除肺栓塞腔静脉滤器

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    机械性吸栓和接触性导管溶栓治疗下肢深静脉血栓形成的疗效对比分析

    祝贺王恒振韩鹏刘冰...
    200-204页
    查看更多>>摘要：目的 比较机械性吸栓（PMT）和接触性导管溶栓（CDT）治疗下肢深静脉血栓形成（DVT）的临床效果。 方法 回顾性分析 2019年 6月至2022 年6月哈尔滨医科大学附属第一医院收治的125例急性中央型或混合型DVT患者的临床资料，其中80例行AngioJet机械吸栓+下腔静脉滤器置入术（PMT组），45例行CDT+下腔静脉滤器置入术（CDT组），比较两组患者的围术期疗效及术后短期随访指标。 结果 PMT组在住院时间、尿激酶用量、溶栓治疗时间方面低于CDT组，差异均具有统计学意义［（5.3±0.8）d 比（7.0±1.0）d，t=10.600，P<0.01；（39.6±9.1）万U 比（126.0±32.4）万U，t=17.522，P<0.01；（1.0±0）d 比（2.1±0.5）d，t=13.681，P<0.01］。两组在不良事件发生率、血栓清除率、患肢周径差及短期随访的Villatla评分和视觉模拟评分，差异均无统计学意义（P均>0.05）。 结论 PMT和CDT在 DVT 患者的治疗中都有满意的术后效果和短期随访结果，PMT组住院时间和溶栓时间较短，溶栓相关并发症较少。 Objective To compare the clinical effects of percutaneous mechanical thrombectom (PMT) and catheter-directed thrombosis (CDT) in the treatment of lower extremity deep venous thrombosis (DVT). Method A retrospective analysis was conducted on the clinical data of 125 patients with acute central or mixed-type DVT at the First Affiliated Hospital of Harbin Medical University from June 2019 to June 2022. Among them, 80 patients who received AngioJet mechanical thrombectomy and inferior vena cava filter implantation were in the PMT group, and 45 patients who received CDT and inferior vena cava filter implantation were in the CDT group. The perioperative efficacy and postoperative follow-up indicators of the two groups were compared. Results The average hospitalization time, urokinase dosage, and thrombolysis treatment time in the PMT group were significantly lower than those in the CDT group, with statistical significance [(5.3±0.8)d vs (7.0±1.0)d, t=10.600, P<0.01 (396 000±91 000)Uvs (1260 000±324 000)U, t=17.522, P<0.01 (1.0±0)dvs (2.1±0.5)d, t=13.681, P<0.01]. There was no statistically significant difference between the two groups in the incidence of adverse events, thrombus clearance rate, difference in limb circumference before and after discharge, and Villatla score and visual analogue scale (VAS) score at 3-6 months of follow-up (P>0.05). Conclusion Both PMT and CDT have satisfactory postoperative results and short-term follow-up efficacy in the treatment of DVT patients. Among them, PMT can significantly shorten the hospital stay, thrombolysis time and reduce perioperative complications related to thrombolysis.

    深静脉血栓形成机械性吸栓导管接触性溶栓

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    8F Zelante和6F Solent血栓去除导管治疗下肢深静脉血栓形成的疗效对比分析

    林越陈刚洪翔洪诗钗...
    205-209页
    查看更多>>摘要：目的 比较8F Zelante和6F Solent血栓去除导管治疗下肢深静脉血栓形成（DVT）的疗效。 方法 回顾性分析复旦大学附属中山医院厦门医院血管外科2020年6月至2022年12月收治的51例急性或亚急性DVT患者的临床资料，其中男性22例，年龄（60.5±14.4）岁。根据血栓去除导管不同，分为Zelante组和Solent组。比较分析两组的溶栓时间、支架植入率、血栓清除率、通畅率、深静脉血栓后综合征（PTS）发生率和并发症等指标。 结果 51例DVT患者中，Zelante组15例，Solent组36例。Zelante组术中吸栓时间［（322.7±78.1）s 比（416.4±61.5）s，t=4.577，P=0.001］和溶栓时间［（46.3±28.8）h 比（96.1±39.5）h，t=2.796，P=0.010］少于Solent组，但总体血栓清除效果优于Solent组（χ2=7.913，P=0.019），差异均具有统计学意义。两组支架植入率、单次住院滤器回收情况比较，差异无统计学意义（P均>0.05）。51例患者均获得随访，随访时间为（12.6±7.1）个月（范围：1~30个月）。随访期间，Zelante组无PTS出现。Solent组中再干预3例；PTS 6例，其中3例为重度。 结论 相较6F Solent血栓去除导管，8F Zelante导管治疗DVT具有更好的血栓清除效果，并发症更少。 Objective To compare the efficacy of 8F Zelante and 6F Solent thrombectomy catheters in the treatment of deep vein thrombosis (DVT) of the lower extremities. Methods The clinical data of 51 patients with acute or subacute DVT admitted to the Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University from June 2020 to December 2022 were prospectively collected and retrospectively analyzed. Among them, there were 22 males, aged (60.5±14.4) years. They were divided into the Zelante group and the Solent group according to different catheters. The thrombolytic time, stent implantation rate, thrombus clearance rate, patency rate, the incidence of post-thrombotic syndrome (PTS), and complications in the two groups were compared. Results There were 15 cases in Zelante group and 36 cases in Solent group. The intraoperative thrombectomy time [(322.7±78.1)s vs. (416.4±61.5)s, t=4.577, P=0.001] and thrombolysis time [(46.3±28.8)h vs. (96.1±39.5)h,t=2.796,P=0.010] in the Zelante group were less than those in the Solent group. The overall thrombus clearance effect in the Zelante group was better than that in the Solent group (χ2=7.913, P=0.019), and the differences were statistically significant. In terms of stent implantation rate and retrieval rate for filters during a single hospital stay, there was no statistically significant difference between the two groups (both P>0.05). All 51 patients were followed up for (12.6±7.1) months (range: 1-30 months). During the follow-up period, there was no PTS in the Zelante group, while in the Solent group, there were 3 cases of reintervention, and 6 cases of PTS, of which 3 cases were severe. Conclusion Compared with 6F Solent catheter, 8F Zelante catheter has a better thrombus clearance effect and fewer complications in the treatment of DVT.

    下肢深静脉血栓形成经皮机械血栓清除溶栓血栓清除率

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