关键词: 导管溶栓；髂静脉球囊扩张；急性下肢深静脉血栓；Cockett综合征；疗效； 安全性

Abstract: Objective To analyze the efficacy and effects of balloon dilation combined with iliac vein balloon dilatation on complications and coagulation function of acute deep venous thrombosis of lower limbs(DVT) complicated with Cockett syndrome.Methods Data of 102 patients with acute DVT combined with Cockett syndrome admitted to the hospital from March 2018 to September 2022 were retrospectively analyzed,including 53 patients treated with catheter thrombolytic balloon dilation of iliac vein (recorded as the study group) and 49 patients treated with catheter thrombolytic therapy (recorded as the control group).Both groups were followed up for 1 year.Thrombosis clearance,edema reduction of affected limb,lower limb hemodynamics,coagulation function,peripheral blood inflammatory factors,complications and thrombosis recurrence were compared between the two groups.Results The thrombus removal grade of the study group was better than that of the control group (P＜0.05).Before and 1 year after surgery,In the control group,the leg circumference diameter difference above the knee between the affected side and the healthy side was (8.02±1.41)cm and (2.89±0.32)cm, respectively.In the study group,the data were (8.19±1.38)cm and (2.57±0.29)cm, respectively.Before and 1 year after surgery,in the control group,the leg circumference diameter difference below the knee between the affected side and the healthy side was (6.84±1.18)cm and (2.13±0.38)cm, respectively.In the study group,the data were (6.63±1.09)cm and (1.76±0.32)cm, respectively.The difference was statistically significant (P < 0.05), and the study group was lower 1 year after surgery (P<0.05).The average blood flow velocity of femoral vein in control group was (24.75±4.03)cm/s and (28.82±4.29)cm/s before and 3 days after surgery, respectively.In the study group,the data were (24.02±3.86)cm/s and (30.94±4.37)cm/s, respectively.The femoral vein blood flow before and 3 days after surgery in the control group was (13.02±2.12)ml/s and (15.05±2.29)ml/s, respectively, while that in the study group was (13.36±2.09)ml/s and (16.26±2.34)ml/s, with statistical significance (P < 0.05).The study group was higher 3 days after surgery(P<0.05).The prothrombin time before and 3 days after operation were (22.93±2.04)s and (18.13±1.34)s in the control group, and (23.24±1.99)s and (17.29±1.21)s in the study group, respectively.The thrombin time before and 3 days after operation were (24.86±2.31)s and (21.04±1.75)s in the control group, and (24.13±2.16)s and (19.89±1.53)s in the observation group, respectively.The activated partial thromboplastin time before and 3 days after surgery was (59.21±3.92)s and (49.13±3.02)s in control group, and (60.17±3.85)s and (47.09±2.98)s in observation group, respectively, and the difference was statistically significant (P<0.05). It was lower 3 days after surgery in study group (P<0.05).In the study group,preoperative tumor necrosis factor (TNF) -α, platelet activating factor (PAF) and thromboxen B2(TXB2) were (31.91±4.89)ng/L, (14.59±2.36)pg/ml, and (213.12±30.98)pg/ml, respectively. Three days after surgery, the levels were (36.24±4.29) ng/L, (16.12±2.59) pg/ml, and (239.86±32.85) pg/ml, respectively, with statistical significance (P < 0.05).TNF-α, PAF and TXB2 were higher in the study group 3 days after surgery (P<0.05).There was no significant difference in the incidence of total complications between the two groups (P>0.05). The recurrence rate of thrombosis in study group was lower than that in control group(3.77% vs 16.33%,P<0.05).Conclusion Catheter thrombolytic balloon dilation of iliac vein for acute DVT complicated with Cockett syndrome can enhance the thrombolysis effect,improve the swelling of the affected limb,lower limb hemodynamics and coagulation function,and reduce the risk of thrombosis recurrence,which is safe and reliable.However,this treatment plan can mediate the occurrence of inflammation,and reasonable anti-inflammatory therapy should be actively implemented after surgery.

Key words: catheter thrombolysis；iliac vein balloon dilatation；acute deep venous thrombosis of lower extremity；Cockett syndrome；curative effect；security