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7 5 2015), XXVII. (, 2016),. (, 2016), VII,, (, 2016), «17 th Meeting of the European Venous Forum» (, 2016), - (, 2017), «18 th Meeting of the European Venous Forum» (, 2017). -», 2017),, 2017). «4-..». (5 ), «2-». (3 ),. (1 ),. (2 ). 10, 8,,. 18 ( 5,29 ), 1, 17,,,, ,,,,. 46, 61 13, ,
8 : 397 (43%), 356 (57%) (24%), (29%), (47%) (17,92%),,,, (P<0,05). (n=30), ( ). (n=30), ( ). (n=30), (n=30). (n=15), ( ). (,,,, ),, 30-. ( 1 ),, (%), ( )., ( 2215 ) 450-,. (ACCP) ( ) Mindray M7 (Shenzhen Mindray Bio-Medical
9 7 Electronics Co. Ltd, ), Samsung Medison SonoAce R7 (Samsung Medison Co. Ltd, ) , «Omnipaque» (Takeda, ),, ),, (General Electric, ).. :,,, ( ) ( >40 ), ( ), ( ),, ( ), ( ), -. 12,, (>1 ). D. Brandjes, S. Villalta.,, : SF-36 Health Status Survey v. 2 (SF-36) Chronic Venous Insufficiency Questionnaire 2 (CIVIQ-2). : ( ) (, ), ( ) (GlaxoSmithKline, ), (Pfizer, ), (Sanofi-Aventis, ); (», ), (Grindex AO, ); (Bayer Pharma AG, ), (Boehringer Ingelheim Pharmaceuticals, Inc., ). ( ). ( ) (5 7 ) ( 3 ).
10 8 ( ) , : , , ( n=753) , 150. ( ). ( ), 2 ( ), 5Fr ( 1) «Prolene» (Ethicon, ),, (ErgonEst, ), ~1 ( 2). 1.
11 9 2. ( ) 10. ( ) 6F (Merit Medical Systems, Inc., ). (Visma-Planar Ltd, ) 3 (, Boehringer Ingelheim Pharma GmbH & Co.KG, ) 50 ( 3). 3.
12 ( >4 ) ( 1,5 2 ). Statisti a 10,0 (StatSoft Inc.,, AXXR012E839529FA). (Shapiro Wilk). ±m, M, m., Me (25% 75%), Me, 25% 75% ,, U- (Mann Whitney), K-W- (Kruskal Wallis). 2. Spearman (r s ). <0,05. 1,1:1. 53%, 47%. ( 45 ) 179 (24%). 75 (10%) : 30 (4%), 45 (6%). 678 (90%), 452 (60%) 226 (30%). 279 (37%), 15 (2%). 74, 10% (2,28%). 21 (51%), 20 (49%), 69,9±15,9. 26 (63,4%)
13 11, 15 (36,6%), :,,. 39 (92,3%). 24 (58,5%). 3 (7,3%),,, (<1 ). (63,4%) 41., 15 (57,7%) , 1,5% (11,1%). 63,5 (56; 70). (85,7%) 42 ( ),,,. 6 (12,5%) ( ). 1 (16,7%), (P>0,05). : 4 16 (38,1%), 3 16 (38,1%), 2 2 (4,8%), 1 4 (9,5%), 4 (9,5%). 17 (40,5%). 15 (13; 20), 9 (7; 11) (U=141, p<0,0001). 6 (20%)» : 4 (13%), 1 (3,5%), 1 (3,5%).
14 12 100%, 3 (2,5; 4), ( 1,8 (1; 2), p<0,05) , ( 1 ) 20 75%. 20 (67%) 22 (73%).,, 12 (40%), 17 (57%) 5 (33%) (p<0,05) ( 1) , n (%) (n=30) 9 (30%) 5 (17%) 6 (20%) 20 (67%) (n=30) 5 (17%) 3 (10%) 4 (13%) 12 (40%) (n=30) 5 (17%) 11 (37%) 6 (20%) 22 (73%) (n=30) 9 (30%) 5 (17%) 3 (10%) 17 (57%) (n=15) 5 (33%) (33%) Villalta, (H=17,66, p=0,001, z 2 3 =3,15, 2 3 =0,016, z 3 5 =3,2, p 3 5 =0,014). Brandjes, (H=24,52, p=0,0001, z 1 4 =2,97, p 1 4 =0,03, z 1 5 =3,4, p 1 5 =0,006, z 2 3 =2,84, 2 3 =0,045, z 3 4 =3,2, p 3 4 =0,015, z 3 5 =3,6, p 3 5 =0,003). 90 (60; 95) %, 22,5 (20; 40) %. 70 (50; 80) %, (22,5 (20;40) %) (50 (50; 65) %).
15 13 (64 (47; 95) ) (51 (42; 61) ),, 29,5 (26; 41), 33 (28; 40), 25 (23; 34) (p<0,05) 2). 2. (n=30) (n=30) (n=30) (n=30) (n=15), % CIVIQ-2, 40 (30; 55) 64 (47; 95) 3 (2; 4) 15 (13; 20) 6 (5; 9) 70 (50; 80) 29 (26; 41) 3 (2; 4) 9 (7; 11) 7,5 (5; 10) 22 (20; 40) 51 (42; 61) 3 (3; 3) 11 (9; 20) 10 (7; 15) 50 (50; 65) 33 (28; 40) 3 (3; 3) 12 (9; 18) 8 (5; 14) 90 (60; 95) 25 (23; 34) 4 (3; 4) 14 (12; 15) 7 (5; 10) H=60,69 p=0,000 H=47,2 p=0,000 H=16,63 p=0,002 H=23,18 p=0,000 H=11,72 p=0,02,,,,, (90%), (37%), (10%) 2%. 1,1:1,. (53%).,,
16 14,, 42,3% (1,45%). 12,5%. 40,5%. (, ) (p>0,05), (p<0,05). 27,8%,,. 1,7%. 60, (61,9%) [1, 6, 12, 13, 15, 24] %, (40%).,, 40% ( ~ 2 ). (r s =0,8 1, p<0,0001), 60 (r s =0,7, p=0,05), (r s =0,6, p 0,05), (r s =0,6, p=0,05), (r s =0,5, p=0,05) (r s =0,5, p=0,05). : ( 20% ), 9 [7 11] (U=141, p<0,0001).,, (30 [26 41], 64 [46 95] (U=170, p<0,0001) [3, 9, 10, 11, 16, 18, 25]. 3. (22,5 [20 40]%), ( 73% ) (37%) (20%) ( 51 [42 61]
17 15 CIVIQ-2)., (50 [50 65]%) (33 [28 40] ) (p<0,05).,, ( 9% )., [2, 4, 5, 7, 14, 17, 19, 23, 26] (60; 95) % (p<0,05), (12- ) ( 33%) (25 [23 34] ). 33%,, 67%, 50% (p<0,05), [8, 20, 21, 22, 27, 28, 29]. 1. : ) ( 1,5 2 ), 2,5 2 ( ) (2 3), ; ) ( 1,5 2 ), , 20 1 [3, 7, 21, 22]. 2. c, 3, 14..
18 16,, 2, 5Fr,. 5-0, ~1 [2, 4, 7, 14, 20, 27]. 3., 3, 14. 6Fr,. 3 ) 50 (, ). 1.. ( [ 50%] ), >4 ) ,5 2 ) [8, 21, 27, 28, 29].
19 17 1. :, /.,.,.,.,. // (11) /.,.,.,.,. // (11) /.,.,.,. // (38) /.,.,.,. // /.,.,.,. // , /.,.,.,. // /.,.,.,. // (76) /.,.,.,.,. // ,. /.,.,. // /.,.,. // /.,.,.,.,. //
20 18 : XV,, /..., :, /.,.,.,.,. // : XV,, /..., :. /.,.,.,.,.,.,. // : XV,, /..., /.,.,.,.,. //, ,.. :, , :, /.,.,.,.,. //, ,.. :, /.,.,.,. //», ,.. :, /.,.,.,.,.,. //», ,.. :, /.,.,.,. // : XXVII...-,., ) /.:. [.];.
21 19.,... :..., /.,.,.,.,. // : XXVII (, ) /.:. [.];..,... :..., , /.,.,.,. // : [ ] /..].,,.. ( 3,7 Mb). :, , /.,.,.,. // VII,,, , , /.,.,.,.,. // ) Khryshchanovich, V. The results of treatment of patients with inferior vena cava thrombosis / V. Khryshchanovich, I. Klimchuk, S. Kalinin // Phlebology Vol. 31 (9). NP12-NP Khryshchanovich, V. Cancer-related vein thrombosis: prevalence, causes and diagnosis / V. Khryshchanovich, S. Kalinin // Phlebology Vol. 31 (9). P Khryshchanovich, V. Long-term results of standard treatment of deep vein thrombosis / V. Khryshchanovich, S. Kalinin // Phlebology Vol. 31 (9). NP12-NP Khryshchanovich, V. Comparative analysis of surgical and conservative treatment of free-floating thrombus in the system of inferior vena cava / V. Khryshchanovich, I. Klimchuk, S. Kalinin // 18 th Meeting of the European Venous
22 20 Forum, 29 June 1 July, 2017, Porto, Portugal. Scientific program and book of abstracts. Edizioni Minerva Medica S.p.A., P A complex approach to the treatment of inferior vena caval thrombosis complicated by floating embolus and acute venous insufficiency / S. Kalinin, V. Khryshchanovich, I. Klimchuk, D. Turlyuk // 18 th Meeting of the European Venous Forum, 29 June 1 July 2017, Porto, Portugal. Scientific program and book of abstracts. Edizioni Minerva Medica S.p.A., P : BY , 61B 5/00, A 61B 17/00 /.,.,., : : /..,.,..,
23 21 :,,,,,,. :. :,,.. : ( 20% ii), ) 40% ~ 2, 9 [7 11] (U=141, p<0,0001), (30 [26 41] 64 [46 95] ; U=170, p<0,0001). i (50 [50 65] %) (33 [28 40] ) (p<0,05). 90 [60 95] % (p<0,05), (12- ) ( 33%) (25 (23; 34) ) CIVIQ-2. : «4-..»., «2-».,.. :,,,.
24 22 :,,,,,,. :. :,,.. : ( 20%» ), 40% ~ 2, 9 [7 11] (U=141, p<0,0001), (30 [26 41] 64 [46 95] ; U=170, p<0,0001). (50 [50 65] %) (33 [28 40] ) (p<0,05). 90 [60 95] % (p<0,05), (12- ) ( 33%) (25 (23; 34) ) CIVIQ-2. : «4-..»., «2-».,.. :,,,.
25 23 SUMMARY Kalinin Sergey Sergeevich Complex treatment of complicated forms of phlebothrombosis in the system of the inferior Vena cava Key words: deep vein thrombosis, phlebothrombosis, pulmonary embolism, venous thromboembolism, post-thrombotic syndrome, thrombolysis. The aim of the study: to improve results of complex treatment of patients with complicated forms of phlebothrombosis in the system of the inferior Vena cava through the development of fundamentally new technologies of local catheter thrombolysis and improvement of methods for surgical thrombectomy. Research methods: clinical, laboratory, instrumental and statistical research methods. The results obtained and their novelty. The use of direct oral anticoagulants allows to improve the immediate and long-term results of anticoagulant therapy in comparison with vitamin K antagonists: to avoid the development of hemorrhagic complications (in comparison with 20% of small bleeding in the background of warfarin therapy), to reduce the PTS level to 40% and to reduce 2 times the frequency of occurrence of moderate and severe PTS, reduce the stay of patients in the hospital to 9 [7 11] days (U=141, p<0.0001), maintain QoL of patients at an acceptable level (30 [26 41] points vs. 64 [46 95] points on admission AVK; U=170, p<0,0001). Thrombectomy with vein plication suggests a better level of recanalization (50 [50 65] %) and higher quality of life (33 [28 40] points) (p<0.05). Local catheter thrombolysis can quickly restore the lumen of the thrombosed vein to 90 [60 95]% (p<0.05), which in the remote (12-month) period leads to a decrease in the frequency of development of PTB (up to 33%) and its severity with preservation of quality of life of patients at an acceptable level (25 (23; 34) points) on the scale CIVIQ-2. Recommendations for use: the results of the study are introduced to the surgical departments of The 4th city clinical hospital named N.E. Savchenko, Minsk, The 2-nd City clinical hospital, Minsk, the state institution Republican hospital of the Department of Finance and logistics of the Ministry of internal Affairs of the Republic of Belarus, Minsk. Field of application: surgery, vascular surgery, cardiology, pulmonology.
26 /16... «Times».... 1, , :».,, 1/ , 6, ,.
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