不同髂静脉压迫病变中支架头端定位特点与临床疗效分析

doi:10.16139/j.1007-9610.2025.02.11

摘要/Abstract

摘要：

目的：探讨支架头端定位在不同髂静脉压迫病变部位的特点与临床疗效。方法：单中心回顾性分析于2021年6月至2023年12月期间本中心收治的经髂静脉支架植入治疗的左侧髂静脉压迫病人。根据压迫部位分为高位、经典与低位。对病人一般信息、病变特点、支架信息、支架通畅度和临床结果等予以随访分析。结果：共242例纳入本研究。220例(90.9%)为经典型，13例(5.4%)为高位型，9例(3.7%)为低位型。三组年龄分布、性别比例、合并症方面差异无统计学意义。高位型支架较经典型支架突出下腔静脉长度明显增加[(3.1±0.8) cm比(1.6±1.0) cm, P<0.001]，而低位型明显减少[(-0.7±2.4) cm比(1.6±1.0) cm, P<0.001]。平均随访时间为(18.0±7.0)个月。支架术后1年和2年通畅率分别为97.0%和92.8%。三组临床症状均有明显缓解，右下肢均未发现新发血栓。结论：经典型髂静脉压迫病变与非经典型髂静脉压迫病变支架头端的定位有明显差异。3种病变类型的治疗均应以支架对病变的完全覆盖作为支架定位的前提。小样本、近期随访数据提示支架在髂静脉高位与低位压迫型病变中同样可缓解临床症状，具有良好的通畅率。

关键词: 慢性静脉疾病, 髂静脉压迫, 支架

Abstract:

Objective To investigate the stent location and effectiveness in different types of iliac vein compression.Methods A retrospective analysis was conducted on patients with left iliac vein compression who underwent stent implantation at our department from June 2021 to December 2023. Based on the location of compression, patients were categorized into high, classical, and low types. The patients’ general information, lesion characteristics, stent details, stent patency, and clinical outcomes were analyzed and followed up.Results A total of 242 patients were included in this study. And 90. 9% (220 cases) were the classical type, 5.4% (13 cases) were the high type, and 3.7% (9 cases) were the low type. There was no significant difference in age distribution, gender ratio and comorbidities among the three groups. The length of inferior vena cava protruding from the high type was significantly longer than that of the classical type[(3.1±0.8) cm vs. (1.6±1.0) cm, P<0.001), but significantly shorter in the low type[(-0.7±2.4) cm vs. (1.6±1.0) cm, P<0.001). The mean follow-up time was (18.0±7.0) months. The stent patency rate was 97.0% at 1 year and 92.8% at 2 years postoperation. The clinical symptoms of the three groups were significantly relieved. No thrombosis was found in right limbs.Conclusions There is a significant difference in the location of the stent tip between classical and non-classical compression types. Complete coverage of lesion by the stent should be the prerequisite for stent placement in treatment of all three types. Small sample, short-term follow-up data suggested that stents can also relieve clinical symptoms and have good patency rate in the high compression type and the low compression type.

Key words: Chronic venous disease, Iliac vein compression, Stent

中图分类号:

R543.6

薛松, 严栋, 施慧华, 赵振, 陆信武, 殷敏毅. 不同髂静脉压迫病变中支架头端定位特点与临床疗效分析[J]. 外科理论与实践, 2025, 30(2): 159-164.

XUE Song, YAN Dong, SHI Huihua, ZHAO Zhen, LU Xinwu, YIN Minyi. Stent location and effectiveness in different types of iliac vein compression[J]. Journal of Surgery Concepts & Practice, 2025, 30(2): 159-164.

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Factors	Total (n=242)	High compression type (n=13, 5.4%)	Classical compression type (n=220, 90.9%)	Low compression type (n=9, 3.7%)	F/χ² value	P value
Age	57.5±9.0	59.5±9.4	57.3±8.9	59.9±8.1	0.701	0.498
Female	164 (67.8)	9 (69.2)	149 (67.7)	6 (66.7)	0.018	0.997
CEAP class
C3	43 (17.8)	0	40 (18.3)	3 (33.3)	4.33	0.106
C4	109 (45.0)	7 (53.9)	102 (46.4)	0	7.94	0.016
C5	60(24.8)	6 (46.2)	51 (23.2)	3 (33.3)	3.84	0.162
C6	30(12.4)	0	27 (12.3)	3 (33.3)	5.48	0.065
Comorbidity
CHD	37 (15.3)	3 (23.1)	31 (14.1)	3 (33.3)	3.12	0.211
Diabetes	36 (14.9)	0	36 (16.4)	0	4.23	0.104
Hypertension	87 (36.0)	3 (23.1)	78 (35.5)	6 (66.7)	3.83	0.147
Hyperlipidemia	63 (26.3)	4 (30.8)	57 (25.9)	2 (22.2)	0.221	0.924
Obesity^a)	34 (14.1)	4 (30.8)	30 (13.6)	0	4.51	0.085
Stenosis (%)	72.3±13.6	69.5±13.6	72.4±13.0	75.3±14.8	0.540	0.584
Venous stent	68（28.1）	4（30.8）	60 （27.3）	4 （44.4）	1.31	0.561
Braided stent	136 (56.2)	9 (69.2)	120 (54.6)	7 (84.6)	2.84	0.228
Protrusion length in IVC （cm）	1.6±0.7	3.1±0.8	1.6±1.0	-0.7±2.4	33.43	<0.001
Follow up (months)	18.0±7.0	18.6±5.6	17.9±7.1	18.4±6.2	0.004	0.957
Clinical remission^b)	2.7±1.1	2.4±1.5	2.7±1.1	2.9±1.7	0.590	0.555