Weaver F A, Meacham P W, Adkins R B, Dean R H
Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
South Med J. 1988 Mar;81(3):306-12. doi: 10.1097/00007611-198803000-00005.
Phlegmasia cerulea dolens (PCD) is a rare venous disorder that continues to be a major therapeutic challenge. We reviewed 16 cases of PCD treated during the past 15 years; 11 of the patients were male, and the average age of all the patients was 59 years. Malignant disease was the most common underlying condition (seven patients). Venous gangrene (VG) was present in seven extremities. Three treatment methods were used alone or in combination--intravenous heparin, venous thrombectomy, and thrombolytic therapy. Heparin was used initially in 13 patients; it yielded a successful result in seven (53%) patients, none of whom had VG. Venous thrombectomy was done in six patients; in three it was the primary procedure, in two it followed failure of heparin, and in one it followed failure of both heparin and thrombolytic therapy. Venous thrombectomy was successful in three (50%) patients, one of whom had early VG. Thrombolytic therapy was used on one occasion in conjunction with both heparin and venous thrombectomy, without benefit. Five patients died, all with VG, three after heparin only, one after heparin and venous thrombectomy, and one after all three treatment methods. Review of the 38 cases reported in the recent literature shows comparable results. These data suggest that nongangrenous forms of PCD respond well to systemic anticoagulation. Combination therapy using venous thrombectomy and heparin is indicated for severe ischemia, early VG, or failure of PCD to improve after six to 12 hours of heparin therapy. Phlegmasia cerulea dolens with VG is the lethal form of the entity and responds poorly to established therapy. Future therapeutic trials need to consider aggressive use of thrombolysis with or without thrombectomy.
股青肿是一种罕见的静脉疾病，仍然是一个重大的治疗挑战。我们回顾了过去15年中治疗的16例股青肿病例；其中11例患者为男性，所有患者的平均年龄为59岁。恶性疾病是最常见的基础疾病（7例患者）。7个肢体出现了静脉坏疽。单独或联合使用了三种治疗方法——静脉注射肝素、静脉血栓切除术和溶栓治疗。最初13例患者使用了肝素；7例（53%）患者取得了成功，其中无一例有静脉坏疽。6例患者进行了静脉血栓切除术；3例将其作为主要手术，2例在肝素治疗失败后进行，1例在肝素和溶栓治疗均失败后进行。静脉血栓切除术在3例（50%）患者中成功，其中1例有早期静脉坏疽。有一次将溶栓治疗与肝素和静脉血栓切除术联合使用，但无效果。5例患者死亡，均有静脉坏疽，3例仅在肝素治疗后死亡，1例在肝素和静脉血栓切除术后死亡，1例在三种治疗方法均使用后死亡。对近期文献报道的38例病例的回顾显示了类似的结果。这些数据表明，非坏疽型股青肿对全身抗凝治疗反应良好。对于严重缺血、早期静脉坏疽或在肝素治疗6至12小时后股青肿仍未改善的情况，建议采用静脉血栓切除术和肝素联合治疗。伴有静脉坏疽的股青肿是该疾病的致死形式，对既定治疗反应不佳。未来的治疗试验需要考虑积极使用溶栓治疗（无论是否进行血栓切除术）。
