ART OF MEDICINE 2017
CHOICE OF THE OPTIMAL PROPHYLAXIS METHOD OF PULMONARY EMBOLISM WITH TROMBOSIS OF THE INFERIOR VENA CAVA SYSTEM
Summary. The aim of research was to substantiate indices of surgical prophylactic of pulmonary embolism.
Methods. The results of investigation and treatment in 790 patients with different forms deep thrombosis at inferior vena cava system have been analyzed. Patients were divided into the groups depending on the treatment. The first group consisted of 555 patients who underwent the surgical treatment with the next conservative treatment. The first A group (n=380) consisted of patients which performed an open full or partial thrombectomy with or without surgical prophylactic of pulmonary thromboembolism. The first B group (n=50) consisted of patients who had the combined treatment with surgical prophylactic of pulmonary thromboembolism. The first C group (n=125) consisted of patients who had an operation with transfascial thrombosis. The second group (n=235) consisted of patients who had only the conservative therapy.
For investigation of patients the following methods were used: the laboratory methods of examination, the instrumental ones: ultrasound duplex scanning, X-ray phlebography, computer tomography and radionuclide fleboscintigraphy. During the radionuclide fleboscintigraphy at rest and during physical activity, the following indicators were determined: the average transport time of the radiopharmaceutical, the linear velocity of the blood and the loading index.
Results. The factors of occurrence of phlebotrombosis influenced the choice of treatment tactics. Most patients had surmountable causes – 502 (63,6%) observations, 129 (16,3%) – not surmountable causes and in 159 (20,1%) patients it was not possible to discover the reason of thrombosis. Most patients – 673 (85,2%) stayed at hospital for the period of 4 or more days from the beginning of the disease, only 117 (14,8%) patients – 3 days for surgery treatment only. Considerable attention ewas paid to the definition of the variant of thrombotic lesion and the nature of thrombotic masses. The expansion of thrombotic occlusion is important for choosing the treatment method. Most patients – 441 (55,8%) – had lesion of one venous segment, the expansion of thrombotic masses in two venous segments was founded in 167 (21,1%) patients, the lesion more than two venous segments was observed in 182 (23,1%) of cases. The upper and lower boundaries of thrombotic masses have been examined. The transition of thrombotic process from the superficial venous system to the deep caused the real threat of pulmonary embolism, in particular, in all 125 (100,0%) patients of first C group, discovered the floating top of the thrombotic masses.The cumulative analysis of the results of the patients’ with thrombosis treatment of inferior vena cava system during 3 years of follow-up showed good and satisfactory results in the first A group were observed in 89,3%, in the first B group – 81,7%, in the first C group – 88, 4% and in the second group – 35,3% of patients.
Conclusions. When choosing the indices for surgical treatment of thrombosis the inferior vena cava system, the cause of thrombosis should be considered, the nature of thrombotic masses, the variant and the spread of thrombotic lesion, the presence of flotation the top of thrombotic masses. The offered medical-diagnostic algorithm allows to effectively prevent the pulmonary embolism.
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