Patel K R, Paidas C N
Department of Surgery (12A3), Metropolitan Hospital Center, New York 10029.
Cardiovasc Surg. 1993 Oct;1(5):518-23.
Thrombectomy and thrombolysis are often advocated in the treatment of phlegmasia cerulea dolens, but frequently result in incomplete clot removal, recurrence of thrombosis, local and systemic hemorrhagic complications and chronic venous stasis; this state is associated with a rate of major amputation and death of up to 50%. Non-operative therapy includes elevation, hydration and heparinization and excludes all methods aimed at surgical removal or chemical lysis of the thrombus. In 1982 it was decided to use non-operative therapy as the first line of treatment for phlegmasia cerulea dolens. In the last 9 years seven extremities in six patients with this condition have been treated. One patient had advanced gangrene on presentation and one underwent emergency thrombectomy. Five extremities (in five patients) were treated with non-operative therapy. Ischemia was rapidly corrected in all five patients. Edema resolved completely after 3-4 days in four patients. There were no complications attributable to the therapy. Two of six (33%) patients died from terminal disease. Non-operative therapy appears to be effective in preventing limb loss and avoiding the risks of thrombectomy and thrombolysis in critically ill patients.
在治疗股青肿时，常提倡采用血栓切除术和溶栓治疗，但这些治疗常常导致血栓清除不完全、血栓复发、局部和全身出血并发症以及慢性静脉淤滞；这种情况的主要截肢率和死亡率高达50%。非手术治疗包括抬高患肢、补液和肝素化，不包括所有旨在手术清除或化学溶解血栓的方法。1982年决定将非手术治疗作为股青肿的一线治疗方法。在过去9年里，对6例患有这种疾病的患者的7条肢体进行了治疗。1例患者就诊时已有严重坏疽，1例行急诊血栓切除术。5条肢体（5例患者）接受了非手术治疗。所有5例患者的缺血情况均迅速得到纠正。4例患者在3 - 4天后水肿完全消退。没有因治疗引起的并发症。6例患者中有2例（33%）死于终末期疾病。非手术治疗似乎在预防肢体丧失以及避免重症患者进行血栓切除术和溶栓治疗的风险方面是有效的。
