Fornaro Rosario, Canaletti Milvia, Terrizzi Antonio, Davi Maria Doris, Bianchi Massimiliano, Sticchi Camilla, Fornaro Michele, Ferraris Romano
Cattedra di semeiotica Chirurgica I, Dipartimento di Discipline Chirurgiche e Metodologie Integrate, Università degli Studi di Genova.
Chir Ital. 2002 Sep-Oct;54(5):729-36.
A case of subclavian-axillary vein thrombosis prompted us to review the recent literature on the subject. Paget-Shroetter disease is an uncommon disease, which is still associated with high early and late morbidity rates and the prevention of which requires early diagnosis and treatment. The importance of trauma (in the form of physical strain) in determining the symptoms of the disease is universally accepted. We observed subclavian-axillary vein thrombosis in a young 22-year-old athlete who complained of unexpected onset of pain in the left armpit, spreading to the arm and to the shoulder on the same side, functional impotence of the upper arm and swelling of the hand and forearm, and engorgement of the vessels in the arm, shoulder and clavipectoral region, which in the course of time developed the characteristics of a collateral circulation. The patient underwent phlebography which documented lack of opacification of the axillo-subclavian axis and showed the presence of a collateral circulation with dilation of the vein of the shoulder and arm. We first attempted to dissolve the thrombus by locoregional infusion of urochinase and later started anticoagulative therapy with an intravenous infusion of heparin (10,000 IU/h after a bolus of 500 units). Because of the poor result of thrombolysis and anticoagulative therapy and the progressive worsening of the disease, the patient underwent surgery to restore the continuity of the venous axis. The surgical procedure was performed through a skin incision along the upper edge of the collar-bone. This was dissected and the two stumps were well separated to allow a clear view of the subclavian vein. Phlebotomy, thrombectomy and reconstruction of the venous axis with an expanded polytetrafluoroethylene patch were performed. The postoperative course was uneventful and the patient underwent phlebography again on postoperative day 8, which demonstrated complete patency of the subclavian vein, and was discharged on postoperative day 20 on oral anticoagulative therapy.
一例锁骨下-腋静脉血栓形成病例促使我们回顾该主题的近期文献。Paget-Shroetter病是一种罕见疾病，其早期和晚期发病率仍然很高，预防该病需要早期诊断和治疗。创伤（以身体劳损的形式）在决定该病症状方面的重要性已得到普遍认可。我们观察到一名22岁的年轻运动员出现锁骨下-腋静脉血栓形成，他主诉左腋窝意外疼痛，疼痛蔓延至同侧手臂和肩部，上臂功能障碍，手部和前臂肿胀，手臂、肩部和锁骨下胸肌区域血管充盈，随着时间推移出现侧支循环的特征。患者接受了静脉造影，结果显示腋-锁骨下静脉轴不显影，并显示存在侧支循环，肩部和手臂静脉扩张。我们首先尝试通过局部注入尿激酶溶解血栓，随后开始静脉输注肝素（推注500单位后以10,000 IU/h的速度输注）进行抗凝治疗。由于溶栓和抗凝治疗效果不佳且病情逐渐恶化，患者接受了手术以恢复静脉轴的连续性。手术通过沿锁骨上缘的皮肤切口进行。切开皮肤并将两个残端充分分离，以便清晰观察锁骨下静脉。进行了静脉切开术、血栓切除术并用膨体聚四氟乙烯补片重建静脉轴。术后过程顺利，患者在术后第8天再次接受静脉造影，显示锁骨下静脉完全通畅，并在术后第20天接受口服抗凝治疗后出院。
