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Article(id=1194617495492464959, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194617490446721194, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1603.2024.1112, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1701964800000, receivedDateStr=2023-12-08, revisedDate=null, revisedDateStr=null, acceptedDate=1712073600000, acceptedDateStr=2024-04-03, onlineDate=1762748605845, onlineDateStr=2025-11-10, pubDate=1740672000000, pubDateStr=2025-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1762748605845, onlineIssueDateStr=2025-11-10, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1762748605845, creator=13701087609, updateTime=1762748605845, updator=13701087609, issue=Issue{id=1194617490446721194, tenantId=1146029695717560320, journalId=1189873630562394117, year='2025', volume='50', issue='2', pageStart='123', pageEnd='244', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1762748604641, creator=13701087609, updateTime=1762749162199, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1194619829073191185, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194617490446721194, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1194619829073191186, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1194617490446721194, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=162, endPage=167, ext={EN=ArticleExt(id=1194617496180330820, articleId=1194617495492464959, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Pulmonary embolism caused by thrombus in a popliteal venous aneurysm: a case report and literature review, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To report the diagnosis and treatment of a case of acute pulmonary embolism caused by thrombus detachment within a popliteal venous aneurysm and conduct a literature review, aiming to enhance the understanding of the disease. Methods The case data of a patient with pulmonary embolism caused by thrombus detachment within a popliteal venous aneurysm who was admitted to the Second Hospital of Lanzhou University were retrospectively analyzed. The relevant literature published from July 2014 to July 2023 in the CNKI and PubMed databases was retrieved, and the diagnosis and treatment methods of the disease were summarized. Results The patient in this case was a 61-year-old male, who was admitted was admitted to the hospital due to "intermittent chest tightness and shortness of breath for 5 days". Color Doppler ultrasound examination and pulmonary artery CT angiography (CTA) suggested popliteal venous aneurysm combined with intramural thrombus and pulmonary embolism. Therefore, the pulmonary embolism and popliteal venous aneurysm were treated surgically in stages. The patient recovered well after the operation and there were no symptoms of chest tightness or shortness of breath after discharge. A total of 11 literatures were retrieved, involving 11 patients, all of whom underwent surgical treatment; Among them, 4 patients were treated with inferior vena cava filter placement, and 2 patients underwent popliteal venous aneurysm surgery after filter placement. Through literature review, it can be known that the etiology of popliteal venous aneurysm remains unclear, and there is no unified standard for diagnosis and treatment. Up to now, surgery is still the preferred option for treatment. Conclusions Patients with popliteal venous aneurysms may be asymptomatic but can lead to deep vein thrombosis of the lower limbs and subsequent pulmonary embolism. Surgical intervention is an effective treatment option. For patients with combined pulmonary embolism, especially those with recurrent pulmonary embolism, it is recommended to perform surgical treatment following placement of an inferior vena cava filter.

, correspAuthors=Zhi-Yong Li, authorNote=null, correspAuthorsNote=
E-mail:
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目的 报告1例腘静脉瘤内血栓脱落所致急性肺栓塞的诊断和治疗情况并进行文献复习，以提高对该病的认识。方法 回顾性分析兰州大学第二医院收治的1例腘静脉瘤内血栓脱落所致肺栓塞患者的病例资料。检索CNKI及PubMed数据库2014年7月－2023年7月发表的相关文献，并总结该病的诊疗方法。结果 患者男，61岁，因“间断性胸闷、气短5 d”入院。彩色多普勒超声检查及肺动脉CT血管造影(CTA)提示腘静脉瘤合并瘤内血栓形成、肺栓塞，遂分期对肺栓塞及腘静脉瘤进行手术治疗。患者术后恢复良好，术后2个月复查未见血栓形成，出院后无胸闷气短症状出现。共检索出11篇英文文献，11例患者，均行手术治疗，其中4例行下腔静脉滤器置入术治疗，2例在滤器置入后行腘静脉瘤手术。通过复习文献可知，腘静脉瘤病因不明，诊疗尚无统一标准；截至目前，手术仍为治疗的优先选择。结论 腘静脉瘤患者可无明显症状，该病可致下肢深静脉血栓形成，进而导致肺栓塞，手术是有效的解决方法。对于合并肺栓塞，特别是复发肺栓塞的患者，建议在完善下腔静脉滤器置入术的前提下再行手术治疗。

, correspAuthors=李志勇, authorNote=null, correspAuthorsNote=
李志勇，E-mail：
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袁东，医学硕士，主治医师，主要从事血管疾病方面的研究

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袁东，医学硕士，主治医师，主要从事血管疾病方面的研究

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袁东，医学硕士，主治医师，主要从事血管疾病方面的研究

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Anesthesiology, 1984, 60(2): 132-135., articleTitle=Volume expansion versus norepinephrine in treatment of a low cardiac output complicating an acute increase in right ventricular afterload in dogs, refAbstract=null), Reference(id=1194646662351130635, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=1999, volume=27, issue=3, pageStart=540, pageEnd=544, url=null, language=null, rfNumber=[19], rfOrder=18, authorNames=Mercat A, Diehl JL, Meyer G, journalName=Crit Care Med, refType=null, unstructuredReference=Mercat A, Diehl JL, Meyer G, et al. Hemodynamic effects of fluid loading in acute massive pulmonary embolism[J]. 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Cochrane Database Syst Rev, 2018, 12(12): CD004437., articleTitle=Thrombolytic therapy for pulmonary embolism, refAbstract=null), Reference(id=1194646662535680014, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=2003, volume=107, issue=null, pageStart=I9, pageEnd=I16, url=null, language=null, rfNumber=[22], rfOrder=21, authorNames=Anderson FAJr, Spencer FA, journalName=Circulation, refType=null, unstructuredReference=Anderson FAJr, Spencer FA. Risk factors for venous thromboembolism[J]. Circulation, 2003, 107(23 Suppl 1): I9-I16., articleTitle=Risk factors for venous thromboembolism, refAbstract=null), Reference(id=1194646662632149007, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=2019, volume=7, issue=6, pageStart=860, pageEnd=864, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=Patel R, Hanish S, Baril D, journalName=J Vasc Surg Venous Lymphat Disord, refType=null, unstructuredReference=Patel R, Hanish S, Baril D, et al. Contemporary management of lower extremity venous aneurysms[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(6): 860-864., articleTitle=Contemporary management of lower extremity venous aneurysms, refAbstract=null), Reference(id=1194646662695063568, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=2018, volume=163, issue=4, pageStart=963, pageEnd=964, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=Cury MVM, Issa AAT, journalName=Surgery, refType=null, unstructuredReference=Cury MVM, Issa AAT. Giant popliteal vein aneurysm in Parkes-Weber syndrome[J]. Surgery, 2018, 163(4): 963-964., articleTitle=Giant popliteal vein aneurysm in Parkes-Weber syndrome, refAbstract=null), Reference(id=1194646662762172433, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=1976, volume=236, issue=22, pageStart=2531, pageEnd=2532, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=Dahl JR, Freed TA, Burke MF, journalName=JAMA, refType=null, unstructuredReference=Dahl JR, Freed TA, Burke MF. Popliteal vein aneurysm with recurrent pulmonary thromboemboli[J]. JAMA, 1976, 236(22): 2531-2532., articleTitle=Popliteal vein aneurysm with recurrent pulmonary thromboemboli, refAbstract=null), Reference(id=1194646662888001554, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=2006, volume=33, issue=2, pageStart=246, pageEnd=248, url=null, language=null, rfNumber=[26], rfOrder=25, authorNames=Herrera LJ, Davis JW, Livesay JJ, journalName=Tex Heart Inst J, refType=null, unstructuredReference=Herrera LJ, Davis JW, Livesay JJ. Popliteal vein aneurysm presenting as a popliteal mass[J]. Tex Heart Inst J, 2006, 33(2): 246-248., articleTitle=Popliteal vein aneurysm presenting as a popliteal mass, refAbstract=null), Reference(id=1194646662955110419, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=2015, volume=29, issue=6, pageStart=1084, pageEnd=1089, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=Johnstone JK, Fleming MD, Gloviczki P, journalName=Ann Vasc Surg, refType=null, unstructuredReference=Johnstone JK, Fleming MD, Gloviczki P, et al. Surgical treatment of popliteal venous aneurysms[J]. Ann Vasc Surg, 2015, 29(6): 1084-1089., articleTitle=Surgical treatment of popliteal venous aneurysms, refAbstract=null), Reference(id=1194646663013830676, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=1993, volume=18, issue=4, pageStart=708, pageEnd=715, url=null, language=null, rfNumber=[28], rfOrder=27, authorNames=Aldridge SC, Comerota AJ, Katz ML, journalName=J Vasc Surg, refType=null, unstructuredReference=Aldridge SC, Comerota AJ, Katz ML, et al. Popliteal venous aneurysm: report of two cases and review of the world literature[J]. J Vasc Surg, 1993, 18(4): 708-715., articleTitle=Popliteal venous aneurysm: report of two cases and review of the world literature, refAbstract=null), Reference(id=1194646663072550933, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=2021, volume=9, issue=1, pageStart=187, pageEnd=192, url=null, language=null, rfNumber=[29], rfOrder=28, authorNames=Beaulieu RJ, Boniakowski AM, Coleman DM, journalName=J Vasc Surg Venous Lymphat Disord, refType=null, unstructuredReference=Beaulieu RJ, Boniakowski AM, Coleman DM, et al. Closed plication is a safe and effective method for treating popliteal vein aneurysm[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9(1): 187-192., articleTitle=Closed plication is a safe and effective method for treating popliteal vein aneurysm, refAbstract=null), Reference(id=1194646663131271190, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, doi=null, pmid=null, pmcid=null, year=2008, volume=48, issue=5, pageStart=1255, pageEnd=1261, url=null, language=null, rfNumber=[30], rfOrder=29, authorNames=Neglén P, Tackett TPJr, Raju S, journalName=J Vasc Surg, refType=null, unstructuredReference=Neglén P, Tackett TPJr, Raju S. Venous stenting across the inguinal ligament[J]. J Vasc Surg, 2008, 48(5): 1255-1261., articleTitle=Venous stenting across the inguinal ligament, refAbstract=null)], funds=[Fund(id=1194646660983788536, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, awardId=21JR11RA121, language=EN, fundingSource=Gansu Provincial Natural Science Foundation(21JR11RA121), fundOrder=null, country=null), Fund(id=1194646661046703097, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, awardId=21JR11RA121, language=CN, fundingSource=甘肃省自然科学基金(21JR11RA121), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1194646657515099082, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, xref=null, ext=[AuthorCompanyExt(id=1194646657523487691, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, companyId=1194646657515099082, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Vascular Surgery, the Second Hospital of Lanzhou University, Lanzhou, Gansu 730030, China), AuthorCompanyExt(id=1194646657531876300, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, companyId=1194646657515099082, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=兰州大学第二医院血管外科，甘肃兰州 730030)])], figs=[ArticleFig(id=1194646659020854250, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=EN, label=Fig.1, caption=CT angiography of pulmonary artery of this patient with popliteal venous aneurysm, figureFileSmall=W3HErTqXAy4QUcybkFgiTg==, figureFileBig=2GF9YK8mxetRS4p1RUfgmg==, tableContent=null), ArticleFig(id=1194646659092157419, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=CN, label=图1, caption=本例腘静脉瘤患者肺动脉CT血管造影结果

A. 左肺；B. 右肺；红色圈示肺动脉内部血栓形成

, figureFileSmall=W3HErTqXAy4QUcybkFgiTg==, figureFileBig=2GF9YK8mxetRS4p1RUfgmg==, tableContent=null), ArticleFig(id=1194646659188626412, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=EN, label=Fig.2, caption=Color Doppler ultrasound result of lower extremity vascular of this patient with popliteal venous aneurysm, figureFileSmall=BfUTJwVkfm9VUzhiGlnWDg==, figureFileBig=4MPdJFbl1yec6oPh63i2/Q==, tableContent=null), ArticleFig(id=1194646659255735277, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=CN, label=图2, caption=本例腘静脉瘤患者下肢血管彩色多普勒超声检查结果

A. 水平面；B. 矢状面；C. 腘静脉走行方向

, figureFileSmall=BfUTJwVkfm9VUzhiGlnWDg==, figureFileBig=4MPdJFbl1yec6oPh63i2/Q==, tableContent=null), ArticleFig(id=1194646659314455534, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=EN, label=Fig.3, caption=Intraoperative pulmonary angiography showing filling defects in this patient with popliteal venous aneurysm, figureFileSmall=9Y5dyaa+cV4iasSg+F84/w==, figureFileBig=hGsgI2xLZUwZDNduurxbhw==, tableContent=null), ArticleFig(id=1194646659364787183, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=CN, label=图3, caption=本例腘静脉瘤患者术中肺动脉造影示肺动脉充盈缺损

A. 左肺；B. 右肺

, figureFileSmall=9Y5dyaa+cV4iasSg+F84/w==, figureFileBig=hGsgI2xLZUwZDNduurxbhw==, tableContent=null), ArticleFig(id=1194646659423507440, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=EN, label=Fig.4, caption=Surgical procedure of this patient with popliteal venous aneurysm, figureFileSmall=gM9i632Lef+hOcRtrOsYaQ==, figureFileBig=0X+gHCWYA9kJX3fZOhNL4w==, tableContent=null), ArticleFig(id=1194646659494810609, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=CN, label=图4, caption=本例腘静脉瘤患者的手术过程

A. 暴露腘静脉瘤；B.腘静脉瘤内部可见血栓形成；C. 腘静脉瘤切除修补后(红色圈为腘静脉瘤切除部分)

, figureFileSmall=gM9i632Lef+hOcRtrOsYaQ==, figureFileBig=0X+gHCWYA9kJX3fZOhNL4w==, tableContent=null), ArticleFig(id=1194646659553530866, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=EN, label=Fig.5, caption=Pathological examination results of this patient with popliteal venous aneurysm, figureFileSmall=W5s9Q7vHS4ay3Zb4S+rKXQ==, figureFileBig=sHWvcDR0Xz7NJ/N724oSBg==, tableContent=null), ArticleFig(id=1194646659620639731, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=CN, label=图5, caption=本例患者腘静脉瘤病理组织学检查结果

A. 切除的血管壁及血栓(大体)；B-D. 切除的血管壁HE染色结果(×400；绿色箭头示内衬单层扁平上皮，黑色箭头示周围管壁纤维组织增生、变性，蓝色箭头示扩张的血管壁)

, figureFileSmall=W5s9Q7vHS4ay3Zb4S+rKXQ==, figureFileBig=sHWvcDR0Xz7NJ/N724oSBg==, tableContent=null), ArticleFig(id=1194646659679359988, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=EN, label=Fig.6, caption=Re-examination of color Doppler ultrasound of this patient with popliteal venous aneurysm at 2 months post-surgery, figureFileSmall=UY06iXWA3h2w5D0lITOgvQ==, figureFileBig=G3/94dOuAW7PPCDGZvQb5w==, tableContent=null), ArticleFig(id=1194646659738080245, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=CN, label=图6, caption=本例腘静脉瘤患者术后2个月彩色多普勒超声复查结果

A. 良好的腘动脉血流信号；B. 良好的腘静脉及动脉血流信号

, figureFileSmall=UY06iXWA3h2w5D0lITOgvQ==, figureFileBig=G3/94dOuAW7PPCDGZvQb5w==, tableContent=null), ArticleFig(id=1194646659805189110, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=EN, label=Tab.1, caption=

Summary of case reports on pulmonary embolism caused by popliteal venous aneurysm

, figureFileSmall=null, figureFileBig=null, tableContent=
文献年份国家性别

年龄

(岁)

症状腘静脉瘤类型治疗方式
Li等[3]2021中国女75PE梭形静脉瘤

肺栓塞：下腔静脉滤器置入术+肺动脉置管溶栓术

静脉瘤：静脉瘤结扎术+静脉搭桥

McBride等[4]2023加拿大女34PE梭形静脉瘤静脉瘤结扎术
Krishan等[5]2021英国女17腘窝肿胀囊状静脉瘤下腔静脉滤器置入术+口服抗凝药
Sandstrom等[6]2016澳大利亚女52PE囊状静脉瘤腘静脉瘤切除术+口服抗凝药物
Kim[7]2022韩国男70VTE囊状静脉瘤静脉瘤切除术+旁静脉修补
Maggiore等[8]2014意大利男38PE囊状静脉瘤下腔静脉滤器置入术+静脉瘤切除术
Premaratne等[9]2014美国女58腘窝疼痛囊状静脉瘤静脉瘤切除术+旁静脉修补
Ghali等[10]2018美国男12PE囊状静脉瘤静脉瘤切除术
Gemayel等[11]2016瑞士男36PE囊状静脉瘤静脉瘤切除术
Sakamoto等[12]2017日本女58PE囊状静脉瘤+梭形静脉瘤下腔静脉滤器置入术
Varetto等[13]2014意大利女43PE囊状静脉瘤+梭形静脉瘤静脉瘤切除术
), ArticleFig(id=1194646659872297975, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1194617495492464959, language=CN, label=表1, caption=

腘静脉瘤引发肺栓塞的病例报告文献汇总

, figureFileSmall=null, figureFileBig=null, tableContent=
文献年份国家性别

年龄

(岁)

症状腘静脉瘤类型治疗方式
Li等[3]2021中国女75PE梭形静脉瘤

肺栓塞：下腔静脉滤器置入术+肺动脉置管溶栓术

静脉瘤：静脉瘤结扎术+静脉搭桥

McBride等[4]2023加拿大女34PE梭形静脉瘤静脉瘤结扎术
Krishan等[5]2021英国女17腘窝肿胀囊状静脉瘤下腔静脉滤器置入术+口服抗凝药
Sandstrom等[6]2016澳大利亚女52PE囊状静脉瘤腘静脉瘤切除术+口服抗凝药物
Kim[7]2022韩国男70VTE囊状静脉瘤静脉瘤切除术+旁静脉修补
Maggiore等[8]2014意大利男38PE囊状静脉瘤下腔静脉滤器置入术+静脉瘤切除术
Premaratne等[9]2014美国女58腘窝疼痛囊状静脉瘤静脉瘤切除术+旁静脉修补
Ghali等[10]2018美国男12PE囊状静脉瘤静脉瘤切除术
Gemayel等[11]2016瑞士男36PE囊状静脉瘤静脉瘤切除术
Sakamoto等[12]2017日本女58PE囊状静脉瘤+梭形静脉瘤下腔静脉滤器置入术
Varetto等[13]2014意大利女43PE囊状静脉瘤+梭形静脉瘤静脉瘤切除术
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腘静脉瘤内血栓所致肺栓塞1例报告并文献复习
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袁东 , 刘涛 , 张嵴明 , 李志勇 *
解放军医学杂志 | 临床研究 2025,50(2): 162-167
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解放军医学杂志 | 临床研究 2025, 50(2): 162-167
腘静脉瘤内血栓所致肺栓塞1例报告并文献复习
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袁东, 刘涛, 张嵴明, 李志勇*
作者信息
  • 兰州大学第二医院血管外科，甘肃兰州 730030

    • 袁东，医学硕士，主治医师，主要从事血管疾病方面的研究

通讯作者:

李志勇，E-mail：
Pulmonary embolism caused by thrombus in a popliteal venous aneurysm: a case report and literature review
Dong Yuan, Tao Liu, Ji-Ming Zhang, Zhi-Yong Li*
Affiliations
  • Department of Vascular Surgery, the Second Hospital of Lanzhou University, Lanzhou, Gansu 730030, China
出版时间: 2025-02-28 doi: 10.11855/j.issn.0577-7402.1603.2024.1112
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摘要
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目的 报告1例腘静脉瘤内血栓脱落所致急性肺栓塞的诊断和治疗情况并进行文献复习，以提高对该病的认识。方法 回顾性分析兰州大学第二医院收治的1例腘静脉瘤内血栓脱落所致肺栓塞患者的病例资料。检索CNKI及PubMed数据库2014年7月－2023年7月发表的相关文献，并总结该病的诊疗方法。结果 患者男，61岁，因“间断性胸闷、气短5 d”入院。彩色多普勒超声检查及肺动脉CT血管造影(CTA)提示腘静脉瘤合并瘤内血栓形成、肺栓塞，遂分期对肺栓塞及腘静脉瘤进行手术治疗。患者术后恢复良好，术后2个月复查未见血栓形成，出院后无胸闷气短症状出现。共检索出11篇英文文献，11例患者，均行手术治疗，其中4例行下腔静脉滤器置入术治疗，2例在滤器置入后行腘静脉瘤手术。通过复习文献可知，腘静脉瘤病因不明，诊疗尚无统一标准；截至目前，手术仍为治疗的优先选择。结论 腘静脉瘤患者可无明显症状，该病可致下肢深静脉血栓形成，进而导致肺栓塞，手术是有效的解决方法。对于合并肺栓塞，特别是复发肺栓塞的患者，建议在完善下腔静脉滤器置入术的前提下再行手术治疗。

腘静脉瘤  /  血栓  /  肺栓塞  /  外科手术

Objective To report the diagnosis and treatment of a case of acute pulmonary embolism caused by thrombus detachment within a popliteal venous aneurysm and conduct a literature review, aiming to enhance the understanding of the disease. Methods The case data of a patient with pulmonary embolism caused by thrombus detachment within a popliteal venous aneurysm who was admitted to the Second Hospital of Lanzhou University were retrospectively analyzed. The relevant literature published from July 2014 to July 2023 in the CNKI and PubMed databases was retrieved, and the diagnosis and treatment methods of the disease were summarized. Results The patient in this case was a 61-year-old male, who was admitted was admitted to the hospital due to "intermittent chest tightness and shortness of breath for 5 days". Color Doppler ultrasound examination and pulmonary artery CT angiography (CTA) suggested popliteal venous aneurysm combined with intramural thrombus and pulmonary embolism. Therefore, the pulmonary embolism and popliteal venous aneurysm were treated surgically in stages. The patient recovered well after the operation and there were no symptoms of chest tightness or shortness of breath after discharge. A total of 11 literatures were retrieved, involving 11 patients, all of whom underwent surgical treatment; Among them, 4 patients were treated with inferior vena cava filter placement, and 2 patients underwent popliteal venous aneurysm surgery after filter placement. Through literature review, it can be known that the etiology of popliteal venous aneurysm remains unclear, and there is no unified standard for diagnosis and treatment. Up to now, surgery is still the preferred option for treatment. Conclusions Patients with popliteal venous aneurysms may be asymptomatic but can lead to deep vein thrombosis of the lower limbs and subsequent pulmonary embolism. Surgical intervention is an effective treatment option. For patients with combined pulmonary embolism, especially those with recurrent pulmonary embolism, it is recommended to perform surgical treatment following placement of an inferior vena cava filter.

popliteal venous aneurysm  /  thrombosis  /  pulmonary embolism  /  surgery
袁东, 刘涛, 张嵴明, 李志勇. 腘静脉瘤内血栓所致肺栓塞1例报告并文献复习. 解放军医学杂志, 2025 , 50 (2) : 162 -167 . DOI: 10.11855/j.issn.0577-7402.1603.2024.1112
Dong Yuan, Tao Liu, Ji-Ming Zhang, Zhi-Yong Li. Pulmonary embolism caused by thrombus in a popliteal venous aneurysm: a case report and literature review[J]. Medical Journal of Chinese People’s Liberation Army, 2025 , 50 (2) : 162 -167 . DOI: 10.11855/j.issn.0577-7402.1603.2024.1112
正文
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腘静脉瘤是一种罕见的静脉病变，尽管其发病率极低，但可导致下肢深静脉血栓及致命性肺栓塞，故近年来逐渐引起了临床的关注。腘静脉瘤的病因尚不明确，目前尚无统一的诊疗方案[1-2]。本研究对1例由腘静脉瘤内血栓脱落引发急性肺栓塞的病例进行分析，检索并复习现有的文献，旨在深化对该病诊断和治疗的认识，为制定更有效的管理策略提供依据。
1 病例报告
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1.1 病史
患者男，61岁，身高177 cm，体重82 kg。因“间断性胸闷、气短5 d”于2022年8月27日就诊于兰州大学第二医院急诊科。患者于5 d前未见明显诱因出现胸闷、气短症状，伴有一过性黑曚，偶发心悸，无胸背部疼痛及肩部放射痛，无大汗淋漓；随即就诊于当地医院，心电图示窦性心动过速、右心室肥大、顺时针转位，心脏彩色多普勒超声检查示肺动脉高压(轻中度)。当地医院建议转院治疗，随即就诊于兰州大学第二医院急诊科。既往患有高血压10年，口服降压药物控制不佳，否认糖尿病、冠心病、传染病及家族遗传病史。
1.2 入院体检
体温(T)36.2 ℃，脉搏(P)96次/min，呼吸(R)25次/min，血压(BP)134/92 mmHg。神志清楚，精神尚可；胸廓对称无畸形，双侧肺呼吸活动度一致，语音震颤未见异常，双侧肺叩诊清音，未闻及明显啰音。心前区无隆起，心尖搏动无弥散，未扪及震颤，心界不大，心音有力、律齐。各瓣膜听诊区未闻及病理性杂音，未闻及心包摩擦音；周围血管征阴性，四肢脉搏搏动可触及，双下肢未见肿胀。
1.3 辅助检查及影像学检查
实验室检查结果示：B型利钠肽原(NT-proBNP)59 pg/ml，超敏肌钙蛋白(Ths-TnT)12.60 ng/L，D-二聚体(D-D)4.72 μg/ml。肺动脉CT血管造影(CTA)示：左、右两侧肺动脉及其分支多发栓子形成(图1A、B)。下肢血管彩色多普勒超声检查提示左侧腘静脉前壁静脉瘤并瘤内血栓形成(图2A-C)，血栓来源基本明确。
1.4 诊断及治疗
患者明确诊断为左下肢腘静脉瘤合并瘤内血栓形成、肺栓塞。为预防发生二次肺栓塞，行下腔静脉滤器置入术+肺动脉造影术+肺动脉置管溶栓术治疗，术中造影可见肺动脉二级分支内存在明显的充盈缺损(图3A、B)，遂经由导丝引导造影导管进入病变血管，通过高压注射泵将与造影剂混合的尿激酶以600 Pa的压力注入，以进行碎栓治疗，术后经留置鞘管及造影导管给予尿激酶及肝素微量泵注射治疗，复查肺动脉造影可见肺动脉通畅。
为防止患者术后再发肺栓塞，在滤器保护下行下肢静脉部分切除及吻合术，于左侧腘窝处行S形切口，依次分离皮下组织，打开阔筋膜后可见腘静脉瘤(图4A)，游离腘静脉远端及近端后使用阻断钳夹闭以阻断血流，切开腘静脉瘤可见内部血栓形成(图4B)，切除部分静脉瘤，修剪切口后，使用5-0 Prolene线缝合腘静脉(图4C)，验证血管通畅性并排气后闭合手术创口。手术结束后将切除的血管壁及血栓(图5A)送病理检查；HE染色结果显示，在腘静脉瘤内壁可见单层扁平上皮，周围管壁存在纤维组织增生和变性，血管壁显著扩张(图5B－D)，支持腘静脉瘤导致血栓形成的诊断；术后给予抗凝药物对症治疗。
1.5 随访
术后2个月随访，复查彩色多普勒超声检查可见血管腔通畅，未见狭窄及新发血栓(图6)，手术切口愈合良好，无新发胸闷气短症状。
2 文献复习
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检索CNKI及PubMed数据库2014年7月－2023年7月所发表的文献，中文关键词为“腘静脉瘤；肺栓塞”，英文关键词为“Popliteal venoma and Pulmonary embolism”，共检出文献53篇；通过阅读文献，剔除不相关及未收录全文的文献42篇，最终纳入文献11篇[3-13]。文献的基本情况如国别、年龄、性别、主要症状、静脉瘤类型及手术方式等详见表1。
文献检索与分析结果显示：腘静脉瘤患者常伴有肺栓塞，以囊状静脉瘤常见；手术是主要的治疗方法，包括静脉瘤结扎、切除及静脉修补等。部分病例在手术前置入下腔静脉滤器或行溶栓治疗，可预防肺栓塞的发生；治疗策略的选择通常基于瘤体类型、患者症状及并发症情况。虽然腘静脉瘤尚无统一的诊疗标准，但手术干预在降低血栓风险方面显示出了良好的效果。
3 讨论
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本例以严重的急性肺栓塞入院，入院后第一时间给予抗凝药物治疗，并调查血栓的来源，最终发现左下肢腘静脉瘤内血栓；待患者生命体征平稳后行下腔静脉滤器置入术及肺动脉高压碎栓术，并留置造影导管和鞘管用于之后的抗凝及溶栓药物灌注，后期行肺动脉造影可见肺动脉栓塞基本治愈。为防止患者再发肺栓塞，行手术切除静脉瘤。
肺栓塞是静脉血栓栓塞(VTE)的一种形式，较小的肺栓塞患者可能不会出现任何症状，而较大的肺栓塞通常会导致呼吸短促和胸痛[14-15]。栓子若大面积阻塞肺动脉可使肺动脉压力突然增高及右心室后负荷增加，从而致使右心室功能障碍，最终可导致患者死亡[16]。因此，对于肺栓塞尤其是出现血流动力学不稳定(收缩压<90 mmHg持续时间超过15 min)的患者，疏通阻塞的肺动脉及呼吸支持至关重要[17]。早期有学者提出运用晶体液扩容来解决患者的休克，但有研究表明，积极扩容可能会导致机械过度拉伸和(或)抑制心肌收缩，从而使右心室功能恶化[18]，但适当的补液则有助于增加肺栓塞患者(合并低心脏指数和正常血压)的心脏指数[19]。导管定向溶栓治疗可快速解决血栓栓塞性阻塞，并在24 h内对右心功能产生有益影响[20]，在加速急性肺栓塞消退、降低肺动脉压力并增加动脉氧合方面具有重要意义[21]。此外，肺栓塞发病因素的识别对血栓之后的治疗也具有指导意义[22]。
腘静脉瘤是下肢静脉瘤中最常见的一种，其并发肺栓塞的概率高达50%~80%，既往有学者统计，腘静脉瘤在静脉疾病中仅占0.06%[1]。由于其罕见性，目前尚未制定明确的诊疗与护理标准。有研究发现，静脉扩张2~3倍可增加静脉内血栓形成的风险[2]。静脉瘤结构的特殊性、低发病率及较晚的发作期可导致诊疗上的不确定性，增加了此类疾病诊疗标准制定的难度[23]。腘静脉瘤病因尚不明确，可能与炎症、创伤及先天性血管畸形有关，如Parkes-Weber综合征可导致巨大腘静脉瘤[24]，也曾报道过体外受精后孕妇患有腘静脉瘤伴肺栓塞的病例[12]，查血可见明显的炎性指标升高。腘静脉瘤无明确症状，可伴有腘窝肿胀、疼痛、下肢溃疡及血栓相关性症状(VTE和肺栓塞引起的下肢肿胀疼痛、胸痛、呼吸困难等)[5]，也可导致瘤内溃疡形成[25]，因此大多数患者是在诊疗过程中偶然发现的。腘静脉瘤可通过下肢血管彩色多普勒超声检查初步明确诊断[5,26]，并可通过CT及MRI明确其解剖结构。
关于腘静脉瘤的治疗目前无统一标准，但基础剂量的抗凝治疗是必要的[27]。从长远来看，单一的抗凝治疗不足以降低患者罹患下肢静脉血栓及肺栓塞的风险[28]，因此手术治疗为必要的选择[21]。目前的手术方法大多为开放式手术治疗，最常用的是腘静脉瘤切除术联合外侧静脉缝合术[25]，若受静脉瘤体积及周围组织炎症影响导致缝合困难，可联合应用静脉移植等方法；最近有学者提出静脉瘤闭合折叠的手术方法，具有良好的初次通畅率和较低的远期复发率[29]。由于腘静脉瘤发生位置的特殊性，不提倡通过介入手术置入支架的方法，因为跨关节置入支架可增加支架狭窄闭塞及骨折的可能性[30]。行开放手术之前应通过彩色多普勒超声检查明确内部有无血栓形成，必要时应于术前行下腔静脉滤器置入术，以预防术中操作导致的肺栓塞。
综上所述，本研究发现，腘静脉瘤可在无明显症状的情况下导致肺栓塞，且手术治疗仍是最有效的选择；在手术前置入下腔静脉滤器可有效预防术中和术后肺栓塞的复发。本例患者术后随访结果良好，未再出现血栓形成或呼吸问题，但仍存在一定的局限性：(1)样本量有限。仅基于单病例报告，缺乏大样本数据支持，难以广泛推广及验证治疗效果。(2)缺乏多中心数据。研究样本单一，未能纳入不同地区和机构的病例，可能影响结论的普适性。(3)随访时间较短。尽管术后随访显示治疗效果良好，但长期疗效和复发率仍不清楚，需进一步延长随访时间。鉴于腘静脉瘤属于罕见疾病，未来建议通过建立罕见病例注册数据库，汇总国内外类似病例数据，以更系统地分析其发病机制和最佳治疗方案，提升研究结果的可靠性。同时，可针对腘静脉瘤导致肺栓塞的高风险因素，逐步制定标准化的诊断与治疗指南，规范临床操作。此外，还可在基础研究中进一步探讨腘静脉瘤的潜在病因(如炎症、血管畸形等)，为更精准的预防和治疗提供科学依据。
基金
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  • 甘肃省自然科学基金(21JR11RA121)
文献
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参考文献 引证文献
排序方式：
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doi: 10.11855/j.issn.0577-7402.1603.2024.1112
  • 接收时间：2023-12-08
  • 首发时间：2025-11-10
  • 出版时间：2025-02-28
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  • 收稿日期：2023-12-08
  • 录用日期：2024-04-03
基金
Gansu Provincial Natural Science Foundation(21JR11RA121)
甘肃省自然科学基金(21JR11RA121)
作者信息
    兰州大学第二医院血管外科，甘肃兰州 730030

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李志勇，E-mail：
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2种不同金属材料的力学参数
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Number of
species		 占总种数比例
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total species (%)		 属
Genus		 种数
Number of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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