Вы находитесь на странице: 1из 5

..., . .. ,1 ..., . .. 2, . ..

2,
... .. 1, ..., . .. 1, ..., . .. 2*
1

1 . .. (. . .. ); 2 1
(. . , . .. )
. .. ,

Comparative study of surgical and conservative tactics in patients with superficial thrombophlebitis
of great saphenous vein
A.V. SHABUNIN1, S.G. GAVRILOV2, A.A. PUSTOVOIT2, T.V. BYCHKOVA1, A.V. KARALKIN1, I.A. ZOLOTUKHIN2*
1
N.I. Pirogov City Clinical Hospital No1, Moscow; 2Department of Level Surgery No 1, Faculty of General Medicine, N.I. Pirogov National
Russian Research Medical University

. . . 79 . 46 , (300 /) ( 1-
) () 5 .
3 . 33 , .
() /
(). 56- , 3 .
1 . .
. 1 (3,0%)
. 2 (4,3%) , . (2,2%)
. 12 (36,4%)
: , , . . 3
/ .
: , , , , .
Aim. This work is focused on the comparative analysis of the surgical and conservative strategies for the prevention of deep venous
thrombosis and/or pulmonary embolism in the patients presenting with superficial thrombophlebitist of great saphenous vein,
GSV (high ligation of (GSV) and anticoagulant therapy respectively). Material and methods. The present comparative prospective
non-randomized study included 79 patients. The study group was comprised of 46 patients prescribed anticoagulant therapy
with subcutaneous administration of unfractioned heparin (for 710 days) at an intermediate dose of 300 U/kg and the early
onset (from day 1) of indirect anticoagulant (warfarin) at a starting dose of 5 mg. The treatment with warfarin lasted 3 months.
Thirty three patients of the control group underwent high ligation of GSV whereas the prescription of heparin therapy was issued
at the discretion of the attending physician. The frequency of deep venous thrombosis (DVT) in the lower extremities and/or
of pulmonary embolism (PE) was assumed to be the criterion for the effectiveness of the treatment in both groups. Ultrasound
scanning was performed at admission of each patient, on days 56 of hospitalization, upon discharge from the hospital, and 3
months after it. Lung perfusion scintiography was performed at admission and one month after discharge. Results and discussion.
None of the patients of the study group developed either DVT or PE. In the control group, one (3.0%) patient developed femoral
vein thrombosis and submassive pulmonary embolism after high ligation of DVT. Two patients in the study group experienced
a rise in the level of thrombophlebitis that required crossectomy. One (2.2%) patient of the same group suffered overdosing
of vitamin K antagonist (warfarin) resulting in weak nasal bleeding. Two (4.3%) patients experienced ST progression up to the
saphenofemoral junction which required the high ligation. Twelve (36.4%) patients in the control group exhibited complications
of crossectomy, hematoma, lymphorrhea, and lymphocele. Conclusion. Anticoagulant therapy of general duration 3 months with
the use of intermediate doses of unfractioned heparin at the initial state of the treatment followed by warfarin intake is an effective
method for the prevention of the development of DVT or PE in the patients with acute ascending varicothrombophlebitis of great
saphenous vein.
Key words: superficial thrombophlebitis, crossectomy, anticoagulants, heparin, warfarin.

, 2013

10

*e-mail: zoloto70@bk.ru

, 2, 2013

() [1].
, ,
.

() [25].

() [68].
: .
,

. [6, 7].
,
. , [8, 9].
,
()
, [10].



, , ,
.


.


79
, 2010 . 2012 . 20
70 ;
(
). :

, ; ; ;
/ ; .
,
, , ,
().
, 2, 2013

56- ,
3 .
.
1 . ,
,
,
() ().
. 1- () , (
) ,
(300 /) ( 1-
)
() 5 .
2,0,
911- , .. .
3 . 2- ()
,
. , ,
3 10 ( 6,43 ).
, .

/ . - .
Statistica 6.0 Microsoft Office Exel 2003.
( , , ).

2, . p<0,05.


79 26 (32,9%)
53 (67,1%) 33 77
( 57,7 ).
46 : 14 (30,4%) 32 (69,6%)
36 73 ( 56,9 ).
17 (36,9%) , 29 (63,1%).
33 : 12 (36,4%)
21 (63,6%) 33 77
( 58,8 ).
16 (48,5%)
, 17 (51,5%). . 1.

, , . -

11

1. ( ), . (%)


(n=46)
14 (30,4)


(n=33)
12 (36,4)

0,301

32 (69,6)

21 (63,6)

0,301

56,98,7

58,8 11,3

0,403

/3

17 (36,9)

2 (6,0)

0,015*

/3

22 (47,8)

7 (21,2)

0,023*

/3

7 (15,2)

24 (72,7)

0,00001*

17 (36,9)

16 (48,5)

0,305

29 (63,1)

17 (51,5)

0,305

2448

2 (4,3)

0,225

4872

5 (10,9)

2 (6,0)

0,458

7296

5 (10,9)

1 (3,0)

0,194

>96

34 (73,9)

30 (90,9)

0,058

. * ; /3 ; /3 ; /3 ; /
.

. 17
(36,9%) , 22 (47,8%)
7 (15,2%) .
2 (6,0%) , 7 (21,2%),
24 (72,7%).
. 1
,
.
3 79 .
,
.
. 2.

. 1 (3,0%)
, 22 500 7 ,
, . 2 (4,3%)

5- . . . ,
/ , .
7 12 ( -

12

10,7; 95% 10,211,2 ), 6


12 ( - 10,2; 95% 9,610,8
). . 1 (2,2%) ,
4,92
. 12
(36,4%) : 10 (30,3%)
, 1 (3,0%), 1 (3,0%).
,
/ , ,

, , .
, .
, ,
,
,
.
F. Lozano A. Almazan [2], 30 ,
,
/ , 2
(6,7%) 30 , , . G. Belcaro . [3]
,

(76 ), , (71).
, 2, 2013

2. , . (%)

(n=46)


(n=33)

1 (3,0)

1 (3,0)

10,65
95% 10,1911,11
1 (2,2)

10,21
95% 9,5910,83
0

0,471

12 (36,4)

:
-

78 , , 2 (2,6%)
[3].
, , . , H. Kock . [11]
44 1 (2,3%) , 1 (2,3%) . F. Lozano A. Almazan [2] 2 (6,7%) 30
.
V. Sullivan . [12]. [2, 12, 13] , , ,
, 12,816,5% .


,
, 30,3% . ,
, .
,

.

.
,
,
.
, ,

,
,
, ,
. , 2 46 .
.
.

, 2, 2013

. , .

: . , , , .
.
:
3
/ .

,
, , .
/ .
.
:
.
:
.., .., ..
.., .., ..
..
.., .., ..
.., .., ..
4 ( )

. ..
,

.

13


1.

Sobreira M.L., Maffei F.H., Yoshida W.B., Rollo H.A., Lastria S., Griva B.L., de Carvalho L.R. Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases. Int Angiol 2009; 28: 5: 400408.

2.

Lozano F.S., Almazan A. Low-molecularweight heparin versus saphenofemoral disconnection for the treatment of above knee greater saphenous
thrombophlebitis: a prospective study. Vasc Endovascular Surg 2003; 37:
415420.

3.

Belcaro G., Nicolaides A.N., Errichi B.M., Cesarone M.R., De Sanctis M.T.,
Incandela L. et al. Superficial thrombophlebitis of the legs: a randomized,
controlled, follow-up study. Angiology 1999; 50: 523529.

4.

Marchiori A., Verlato F., Sabbion P., Camporese G., Rosso F., Mosena L. et al.
High versus low doses of unfractionated heparin for the treatment of superficial thrombophlebitis of the leg. A prospective, controlled, randomized
study. Haematologica 2002; 87: 523527.

5.

The STENOX Study Group. A randomized double-blind comparison of


low molecular weight heparin, non steroidal antiinammatory agent and
placebo in the treatment of supercial vein thrombosis. Arch Intern Med
2003; 163: 16571663.

6.

Decousus H., Qur I., Leizorovicz A. Three-month incidence of venous


thromboembolism (VTE) in patients with isolated superficial thrombophlebitis (ST): preliminary results of the post study. J Thromb Haemost 2007; 5:
Suppl 2: L:O-S059.

7.

.., .. :
, .
1999; 7: 13: 600604.

14

8.

.., .., .., .. .


- 2003; 2: 4346.

9.

.., .., .., .., ..,


.. -
. 2010; 2: 2025.

10.

Kearon C., Kahn S.R., Agnelli G., Goldhaber S.Z., Raskob G., Comerota A.J.
Antithrombotic therapy for venous thromboembolic disease: ACCP evidence-based clinical practice guidelines (8th ed). Chest 2008; 133: 454
454.

11.

Kock H.J., Krause U., Albrecht K.H., an der Laan, Rudofsky G., Eigler F.W.
Crossectomy is ascending superficial thrombophlebitis of the leg veins.
J Zentrabl Chir 1997; 122: 9: 795800.

12.

Sullivan V., Denk P.M., Sonnad S.S., Eagleton. J., Wakefieal T.W. Ligation
versus anticoagulation : treatment of above-knee superficial thrombophlebitis not involving the deep venous system. J Am Coll Surg 2001; 193: 5:
556562.

13.

Decousus H., Epinat M., Guillot K., Quenet S., Boisser C., Tardy B. Supercial
vein thrombosis: risk factors, diagnosis and treatment. Curr Opin Pulm
Med 2003; 9: 393397.

, 2, 2013