Abstract:

Current situation and trend of treatment of deep vein thrombosis        LI Wen-dong，LI Xiao-qiang，XIAO Lun. Department of Vascular Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
Corresponding author: LI Xiao-qiang, E-mail：flytsg@126.com
Abstract    Deep vein thrombosis （DVT）， which can complicate with pulmonary embolism （PE） and develop into postthrombotic syndrome （PTS）， is a troublesome problem in clinic. Thus， the treatment of DVT mainly includes two aspects： （1）protection from symptomatic PE and sprawled thrombus；（2）protection from PTS. Sufficient and effective anticoagulation is the fundamental treatment for acute DVT. New oral anticoagulation drugs facilitate the treatment of anticoagulation by avoiding monitor of coagulation function. But in some patients with contraindications for anticoagulation， inferior vena cava filter is necessary for preventing fatal PE. Retrieval filter with a wide duration of withdrawal is attractive in clinic. Removing thrombi by embolectomy，catheter-directed thrombolysis and pharmacomechanical thrombolysis can facilitate to restore the blood flow. But the methods of removal thrombi tend to invasive and efficient. Patients with DVT are always complicated with iliac vein compression. Stenting to solve the obstructive iliac vein is necessary when thrombi are removed. Long-term anticoagulation for prevention of recurrent DVT is necessary for protecting from PTS. Compression including stocking compression and intermittent pneumatic compression contributes to reducing the symptoms of DVT.

Key words: deep vein thrombosis, pulmonary embolism, postthrombotic syndrome, anticoagulation, inferior vena cava filter, thrombectomy

摘要：

下肢深静脉血栓形成（DVT）是临床常见疾病。肺动脉栓塞（PE）和血栓后综合征（PTS）是其两大并发症。其临床治疗在于预防血栓蔓延、预防症状性PE和预防PTS发生。充分有效的抗凝治疗是急性DVT的基本治疗方式，新型口服抗凝药物可避免反复监测凝血功能，方便抗凝治疗。但对于有抗凝禁忌证者，下腔静脉滤器可作为一种替代治疗，能有效预防致命性PE的发生。随着可回收滤器取出时间窗的延长，可回收滤器也越来越受到关注。血栓清除术包括手术切开取栓术、导管接触性溶栓及机械-药物溶栓术等，有利于血流的再通，目前这些血栓清除的方式趋于微创和高效。DVT常合并髂静脉受压综合征，当血栓清除后，髂静脉支架解除髂静脉阻塞有利于预防PTS的发生。同时长期口服抗凝药物也是预防PTS发生的一项重要治疗措施，压力治疗包括弹力袜治疗和循环驱动治疗也可减轻DVT的症状。

关键词: 深静脉血栓形成, 肺动脉栓塞, 血栓后综合征, 抗凝治疗, 下腔静脉滤器, 血栓清除术