摘要
目的:探讨盆腔恶性肿瘤并发急性下肢深静脉血栓形成(DVT)原因及腔内治疗经验。方法:对2009年1月至2015年3月收治经导管接触性溶栓(CDT)及球囊扩张(PTA)或联合支架植入(髂静脉狭窄≥50%时)治疗32例盆腔恶性肿瘤并发急性下肢DVT患者临床资料进行回顾性分析。结果:32例患者CDT前均置入腔静脉滤器(VCF),溶栓时间为(5.3±2.6)d,尿激酶用量(320±130)万U,溶栓后下肢深静脉平均通畅率为(83.7±16.9)%,溶栓期间仅3例出现轻度出血,调整用药后消失。13例髂静脉狭窄≥50%行支架植入治疗,共植入支架17枚;11例髂静脉狭窄在30%~49%之间仅行PTA;8例髂静脉狭窄<30%未行球囊扩张及支架植入。治疗期间无症状性肺栓塞(PE)发生。30例患者获得随访,随访(13.6±5.4)个月,6例下肢深静脉血栓复发,其中1例支架内血栓复发,4例血栓复发原髂静脉狭窄在30%~49%之间,1例血栓复发原髂静脉狭窄<30%。均再次CDT联合PTA及支架植入治疗成功。结论:盆腔恶性肿瘤及放疗是发生急性下肢DVT、血栓复发的危险因素,血管腔内介入治疗是积极有效的治疗方法;当髂静脉狭窄超过30%时,我们建议支架植入治疗。
Objective：To explore the causes of acute lower extremity deep vein thrombosis（DVT）with pelvic malignant tumors and their experience in endovascular treatment in patients.Methods：The clinical data of 32 patients with pelvic malignant tumor complicated with acute DVT of lower extremities,treated by the catheter-induced thrombolysis（CDT）and balloon dilatation or stenting （iliac vein stenosis ≥50%） from January 2009 to March 2015 were analyzed retrospectively.Results：The vena cava filters （VCF） were placed before CDT in all patients,thrombolysis time was （5.3±2.6） d,urokinase dosage （320±130） million U.The average patency rate was （83.7±16.9）% after CDT.Of 32 cases,only 3 cases presented mild bleeding during thrombolysis,and stopped bleeding after adjustment of medication.13 cases of iliac vein stenosis ≥ 50% received stenting who were implanted in 17 stents,11 cases of iliac vein stenosis between 30% to 49% only PTA,8 cases of iliac vein stenosis 〈30% without balloon dilatation and stent implantation.During treatment,asymptomatic pulmonary embolism （PE） occurs.Thirty patients were followed up for （13.6±5.4） months.During the follow-up time,DVT recurrence occurred in 6 cases,including 1 case of stent,4 cases of the iliac vein stenosis in 30% to 49%,1 case of the iliac vein stenosis 〈30%,which were again CDT combined with PTA and Stent treatment success.Conclusion：Pelvic malignant tumor and radiotherapy are the risk factors which could led to lower extremity DVT and thrombosis recurrence.Intravascular interventional therapy is a positive and effective treatment.When iliac vein stenosis is more than 30%,we believe that stent implantation should be done.
出处
《现代肿瘤医学》
CAS
2018年第4期612-616,共5页
Journal of Modern Oncology
关键词
盆腔肿瘤
髂静脉狭窄
深静脉血栓形成
支架
导管溶栓
pelvic tumor, iliac vein stenosis, deep vein thrombosis, stent, catheter thrombolysis
