目的 探讨肾病综合征并发血栓形成的外科治疗特点。
方法 从笔者所在单位收治的肾病综合征并发血栓形成的患者中选取4例血栓形成部位罕见、治疗难度大的病例,对其临床资料进行分析。
结果 1例在下肢深静脉血栓形成基础上发生下腔静脉血栓形成;1例腹主动脉急性血栓形成伴下肢动脉栓塞导致下肢坏疽行高位截肢;1例股动脉支架内反复血栓形成导致下肢坏疽行高位截肢;1例人工血管及下肢动脉支架内短时间内血栓形成,经干细胞移植后下肢缺血得到缓解。
结论 在血栓形成的诊治过程中提高对肾病综合征的认识,针对肾病综合征患者高凝状态在围手术期进行预防性抗凝治疗,以及充分认识肾病综合征并发血栓形成抗凝治疗的特殊性,可能会降低肾病综合征患者血栓形成的发生率,提高肾病综合征并发血栓形成的外科治疗水平。
Citation:
佟铸,谷涌泉,李学锋,郭连瑞,郭建明,武欣,刘梦霞,李建新,张建,汪忠镐. Surgery Therapy of Thrombosis Accompanied with Nephrotic Syndrome:Report of 4 Cases and Literature Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(7): 765-767. doi:
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马玉奎, 赵纪春, 胡志. 下肢深静脉血栓形成的诊断及综合治疗 [J]. 中国普外基础与临床杂志, 2008, 15(1): 56-58.
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Daneschvar HL, Seddighzadeh A, Piazza G, et al. Deep vein thrombosis in patients with chronic kidney disease [J]. Thromb Haemost, 2008, 99(6):1035-1039.
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周建华. 肾静脉栓塞的治疗 [J]. 实用儿科临床杂志, 2003,18(9): 682-684.
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Charlesworth JA, Gracey DM, Pussell BA. Adult nephrotic syndrome: non-specific strategies for treatment [J]. Nephrology (Carlton), 2008, 13(1): 45-50.
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Schrier RW, Masoumi A, Elhassan E. et al. Aldosterone:role in edematous disorders, hypertension, chronic renal failure, and metabolic syndrome [J]. Clin J Am Soc Nephrol, 2010, 5(6):1132-1140.
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Aizawa-Yashiro T, Tsuruga K, Watanabe S, et al. Novel multidrug therapy for children with cyclosporine-resistant or -intolerant nephrotic syndrome [J]. Pediatr Nephrol, 2011, 26(8):1255-1261.
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Nikibakhsh AA, Mahmoodzadeh H, Karamyyar M, et al. Treatment of steroid and cyclosporine-resistant idiopathic nephrotic syndrome in children [J]. Int J Nephrol, 2011:930965.
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Jang HR, Jung HW, Lee YJ, et al. Combination treatment with corticosteroid, cyclosporine A, and mycophenolate in refractory nephrotic syndrome [J]. Clin Nephrol, 2011, 75(6):511-517.
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Kato S, Chernyavsky S, Tokita JE, et al. Relationship between proteinuria and venous thromboembolism [J]. J Thromb Thrombolysis,2010, 30(3): 281-285.
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Bramham K, Hunt BJ, Goldsmith D. Thrombophilia of nephrotic syndrome in adults [J]. Clin Adv Hematol Oncol, 2009, 7(6):368-372.
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- 1. 陈灏珠主编. 实用内科学 [M]. 第11 版. 北京: 人民卫生出版社, 2002:2001-2007.
- 2. Maeda A, Takeda K, Kondou H, et al. Percutaneous renal artery embolization in a patient with severe nephrotic syndrome which continued after the introduction of hemodialysis [J]. Intern Med, 2011, 50(23):2899-2904.
- 3. Mahmoodi BK, ten Kate MK, Waanders F, et al. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome:results from a large retrospective cohort study [J]. Circulation, 2008, 117(2): 224-230.
- 4. 谷涌泉, 杨盛家. 外周动脉血栓性疾病诊断和治疗 [J]. 医学研究杂志, 2006, 35(7):7-9.
- 5. Park SJ, Shin JI. Complications of nephrotic syndrome [J]. Korean J Pediatr, 2011, 54(8):322-328.
- 6. 马玉奎, 赵纪春, 胡志. 下肢深静脉血栓形成的诊断及综合治疗 [J]. 中国普外基础与临床杂志, 2008, 15(1): 56-58.
- 7. Daneschvar HL, Seddighzadeh A, Piazza G, et al. Deep vein thrombosis in patients with chronic kidney disease [J]. Thromb Haemost, 2008, 99(6):1035-1039.
- 8. 周建华. 肾静脉栓塞的治疗 [J]. 实用儿科临床杂志, 2003,18(9): 682-684.
- 9. Charlesworth JA, Gracey DM, Pussell BA. Adult nephrotic syndrome: non-specific strategies for treatment [J]. Nephrology (Carlton), 2008, 13(1): 45-50.
- 10. Schrier RW, Masoumi A, Elhassan E. et al. Aldosterone:role in edematous disorders, hypertension, chronic renal failure, and metabolic syndrome [J]. Clin J Am Soc Nephrol, 2010, 5(6):1132-1140.
- 11. Aizawa-Yashiro T, Tsuruga K, Watanabe S, et al. Novel multidrug therapy for children with cyclosporine-resistant or -intolerant nephrotic syndrome [J]. Pediatr Nephrol, 2011, 26(8):1255-1261.
- 12. Nikibakhsh AA, Mahmoodzadeh H, Karamyyar M, et al. Treatment of steroid and cyclosporine-resistant idiopathic nephrotic syndrome in children [J]. Int J Nephrol, 2011:930965.
- 13. Jang HR, Jung HW, Lee YJ, et al. Combination treatment with corticosteroid, cyclosporine A, and mycophenolate in refractory nephrotic syndrome [J]. Clin Nephrol, 2011, 75(6):511-517.
- 14. Kato S, Chernyavsky S, Tokita JE, et al. Relationship between proteinuria and venous thromboembolism [J]. J Thromb Thrombolysis,2010, 30(3): 281-285.
- 15. Bramham K, Hunt BJ, Goldsmith D. Thrombophilia of nephrotic syndrome in adults [J]. Clin Adv Hematol Oncol, 2009, 7(6):368-372.