Construction and practice of enhanced recovery after surgery system for treatment of lower extremity deep venous thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Fenghe , WANG Xuehu , ZENG Qiu , ZHU Hua ,  ZHAO Yu

Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding?author：

ZHAO Yu, Email: 820994765@qq.com

Keywords：

deep vein thrombosis; “Six-Step” comprehensive treatment protocol; enhanced recovery after surgery

DOI：

10.7507/1007-9424.202503122

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With the widespread promotion and application of the Enhanced Recovery After Surgery (ERAS) concept in the surgical fields, the implementation of the ERAS concept in the treatment of lower extremity deep venous thrombosis (DVT) was explored in the vascular surgery. The “Six-Step” comprehensive treatment protocol and the establishment of the ERAS system for lower extremity DVT developed by the Department of Vascular Surgery at the First Affiliated Hospital of Chongqing Medical University were elaborated. The protocol includes steps such as filter placement, thrombus clearance, relief of venous outflow obstruction, dissolution of residual thrombus, filter retrieval, and standardized post-discharge anticoagulation management, along with their respective advantages. Additionally, the training and dissemination efforts undertaken to promote the “Six-Step” comprehensive treatment protocol were described. A comparison was made between ERAS and traditional recovery surgery, highlighting the comprehensive clinical benefits of the former. The aim is to promote the standardized implementation of the ERAS system in lower extremity DVT treatment and to bring greater benefits to patients.

Citation： LI Fenghe, WANG Xuehu, ZENG Qiu, ZHU Hua, ZHAO Yu. Construction and practice of enhanced recovery after surgery system for treatment of lower extremity deep venous thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(4): 410-415. doi: 10.7507/1007-9424.202503122 Copy

1.	李春雨, 韓超, 李犖蕓, 等. 加速康復外科(ERAS)理念的由來及發展. 中華醫史雜志, 2017, 47(2): 124-127.
2.	陳晨, 魏來. 肝膽胰外科疾病加速康復外科臨床路徑湖南專家共識(2022版). 中國普通外科雜志, 2022, 31(7): 847-859.
3.	嚴鵬科, 梅崢嶸, 施勝英, 等. 剖宮產術后快速康復藥學服務專家共識. 今日藥學, 2023, 33(3): 161-71.
4.	尹健, 王國年, 強萬敏, 等. 乳房再造加速康復外科中國專家共識(2022版). 中國腫瘤臨床, 2023, 50(8): 379-384.
5.	徐麗麗, 劉序強. 全膝關節置換術后膝關節功能加速康復專家共識. 山東大學學報(醫學版), 2024, 62(10): 48-61.
6.	Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
7.	公茂峰, 顧建平. 深靜脈血栓形成的個性化抗凝治療策略. 中國臨床研究, 2025, 38(2): 165-168.
8.	中華醫學會外科學分會血管外科學組. 腔靜脈濾器臨床應用指南解讀. 中華血管外科雜志, 2019, 4(3): 145-153.
9.	張福先. 腔靜脈濾器的規范性應用與并發癥的預防. 中國普外基礎與臨床雜志, 2020, 27(4): 396-399.
10.	黃章偉, 李慶, 唐博. 可回收下腔靜脈濾器放置與并發癥關系的研究進展. 臨床醫學進展, 2024, 14(2): 4301-4309.
11.	史振宇, 符偉國. 下肢深靜脈血栓清除的現狀與進展. 中華血管外科雜志, 2023, 8(2): 170-174.
12.	祖慶佩, 朱吉海. 靜脈血栓栓塞癥治療的新進展. 臨床醫學進展, 2023, 13(6): 10081-10087.
13.	趙得銀, 于智勇, 張艮龍, 等. 不同置管入路溶栓治療急性下肢深靜脈血栓形成的應用效果. 實用醫學雜志, 2020, 36(16): 2269-2272.
14.	Goldhaber SZ, Magnuson EA, Chinnakondepalli KM, et al. Catheter-directed thrombolysis for deep vein thrombosis: 2021 update. Vasc Med, 2021, 26(6): 662-669.
15.	張拓, 劉坤, 郭興友, 等. 導管接觸性溶栓與機械血栓清除治療急性下肢深靜脈血栓的臨床療效對比. 中國急救復蘇與災害醫學雜志, 2023, 18(10): 1366-1369.
16.	田晨陽, 田軒, 劉建龍, 等. 順行與逆行入路機械性血栓清除術治療急性下肢深靜脈血栓的前瞻性隨機對照研究. 中國普通外科雜志, 2024, 33(12): 1983-1994.
17.	Pan Y, Li Y, Chen Y, et al. Dual-frequency ultrasound assisted thrombolysis in interventional therapy of deep vein thrombosis. Adv Healthc Mater, 2024, 13(9): e2303358. doi: 10.1002/adhm.202303358.
18.	Shi Y, Shi W, Chen L, et al. A systematic review of ultrasound-accelerated catheter-directed thrombolysis in the treatment of deep vein thrombosis. J Thromb Thrombolysis, 2018, 45(3): 440-451.
19.	許天澤, 李曉強. 髂靜脈受壓綜合征與下肢深靜脈血栓形成相關性的研究進展. 中華血管外科雜志, 2021, 6(1): 68-71.
20.	趙渝, 李德衛, 時德, 等. 髂靜脈受壓綜合征的解剖基礎. 中國實用外科雜志, 2003, 23(12): 745-746.
21.	陶黎, 朱嵬, 張曉宇, 等. NCE-MRA在評價髂靜脈受壓分型中的應用價值. 血管與腔內血管外科雜志, 2022, 8(1): 17-21.
22.	中華醫學會外科學分會血管外科學組. 深靜脈血栓形成的診斷和治療指南(第三版). 中華普通外科雜志, 2017, 32(9): 807-812.
23.	Shebel ND, Whalen CC. Diagnosis and management of iliac vein compression syndrome. J Vasc Nurs, 2005, 23(1): 10-17.
24.	Pouncey AL, Gwozdz AM, Johnson OW, et al. AngioJet pharmacomechanical thrombectomy and catheter directed thrombolysis vs. catheter directed thrombolysis alone for the treatment of iliofemoral deep vein thrombosis: a single centre retrospective cohort study. Eur J Vasc Endovasc Surg, 2020, 60(4): 578-585.
25.	徐葉亮. 下肢深靜脈血栓形成后綜合征危險因素及預防策略的研究進展. 臨床醫學進展, 2024, 14(2): 2426-2433.
26.	國際血管聯盟中國分部護理專業委員會. 周圍血管血栓性疾病置管溶栓護理專家共識. 介入放射學雜志, 2022, 31(11): 1045-1051.
27.	吳學君, 金星, 郭培明, 等. 下肢深靜脈血栓后綜合征預防措施的臨床研究. 中國普通外科雜志, 2006, 15(5): 338-342.
28.	曾祥熙, 譚風美, 裘法祖. 在外科醫療工作中貫徹“二減一保”的體會. 中華外科雜志, 1966, 14(5): 281-283.
29.	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
30.	中華醫學會外科學分會, 中華醫學會麻醉學分會. 中國加速康復外科臨床實踐指南(2021版). 中國實用外科雜志, 2021, 41(9): 961-992.
31.	江志偉, 李寧黎介壽. 應用快速康復外科理念進行胃腸癌手術時的營養管理. 中國臨床腫瘤學教育專輯, 2007: 291-295.
32.	中國研究型醫院學會肝膽胰外科專業委員會. 肝膽胰外科術后加速康復專家共識(2015版). 中華消化外科雜志, 2016, 15(1): 1-6.
33.	中華醫學會外科學分會, 中華醫學會麻醉學分會. 中國加速康復外科臨床實踐指南(2021)(二). 協和醫學雜志, 2021, 12(5): 632-640.
34.	Zhang L, Jiang C, Chen Z, et al. Three-year outcomes, risk factors for restenosis after stenting for DVT combined with iliac vein compression syndrome. Clin Appl Thromb Hemost, 2024, 30: 10760296241283821. doi: 10.1177/10760296241283821.

1. 李春雨, 韓超, 李犖蕓, 等. 加速康復外科(ERAS)理念的由來及發展. 中華醫史雜志, 2017, 47(2): 124-127.
2. 陳晨, 魏來. 肝膽胰外科疾病加速康復外科臨床路徑湖南專家共識(2022版). 中國普通外科雜志, 2022, 31(7): 847-859.
3. 嚴鵬科, 梅崢嶸, 施勝英, 等. 剖宮產術后快速康復藥學服務專家共識. 今日藥學, 2023, 33(3): 161-71.
4. 尹健, 王國年, 強萬敏, 等. 乳房再造加速康復外科中國專家共識(2022版). 中國腫瘤臨床, 2023, 50(8): 379-384.
5. 徐麗麗, 劉序強. 全膝關節置換術后膝關節功能加速康復專家共識. 山東大學學報(醫學版), 2024, 62(10): 48-61.
6. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
7. 公茂峰, 顧建平. 深靜脈血栓形成的個性化抗凝治療策略. 中國臨床研究, 2025, 38(2): 165-168.
8. 中華醫學會外科學分會血管外科學組. 腔靜脈濾器臨床應用指南解讀. 中華血管外科雜志, 2019, 4(3): 145-153.
9. 張福先. 腔靜脈濾器的規范性應用與并發癥的預防. 中國普外基礎與臨床雜志, 2020, 27(4): 396-399.
10. 黃章偉, 李慶, 唐博. 可回收下腔靜脈濾器放置與并發癥關系的研究進展. 臨床醫學進展, 2024, 14(2): 4301-4309.
11. 史振宇, 符偉國. 下肢深靜脈血栓清除的現狀與進展. 中華血管外科雜志, 2023, 8(2): 170-174.
12. 祖慶佩, 朱吉海. 靜脈血栓栓塞癥治療的新進展. 臨床醫學進展, 2023, 13(6): 10081-10087.
13. 趙得銀, 于智勇, 張艮龍, 等. 不同置管入路溶栓治療急性下肢深靜脈血栓形成的應用效果. 實用醫學雜志, 2020, 36(16): 2269-2272.
14. Goldhaber SZ, Magnuson EA, Chinnakondepalli KM, et al. Catheter-directed thrombolysis for deep vein thrombosis: 2021 update. Vasc Med, 2021, 26(6): 662-669.
15. 張拓, 劉坤, 郭興友, 等. 導管接觸性溶栓與機械血栓清除治療急性下肢深靜脈血栓的臨床療效對比. 中國急救復蘇與災害醫學雜志, 2023, 18(10): 1366-1369.
16. 田晨陽, 田軒, 劉建龍, 等. 順行與逆行入路機械性血栓清除術治療急性下肢深靜脈血栓的前瞻性隨機對照研究. 中國普通外科雜志, 2024, 33(12): 1983-1994.
17. Pan Y, Li Y, Chen Y, et al. Dual-frequency ultrasound assisted thrombolysis in interventional therapy of deep vein thrombosis. Adv Healthc Mater, 2024, 13(9): e2303358. doi: 10.1002/adhm.202303358.
18. Shi Y, Shi W, Chen L, et al. A systematic review of ultrasound-accelerated catheter-directed thrombolysis in the treatment of deep vein thrombosis. J Thromb Thrombolysis, 2018, 45(3): 440-451.
19. 許天澤, 李曉強. 髂靜脈受壓綜合征與下肢深靜脈血栓形成相關性的研究進展. 中華血管外科雜志, 2021, 6(1): 68-71.
20. 趙渝, 李德衛, 時德, 等. 髂靜脈受壓綜合征的解剖基礎. 中國實用外科雜志, 2003, 23(12): 745-746.
21. 陶黎, 朱嵬, 張曉宇, 等. NCE-MRA在評價髂靜脈受壓分型中的應用價值. 血管與腔內血管外科雜志, 2022, 8(1): 17-21.
22. 中華醫學會外科學分會血管外科學組. 深靜脈血栓形成的診斷和治療指南(第三版). 中華普通外科雜志, 2017, 32(9): 807-812.
23. Shebel ND, Whalen CC. Diagnosis and management of iliac vein compression syndrome. J Vasc Nurs, 2005, 23(1): 10-17.
24. Pouncey AL, Gwozdz AM, Johnson OW, et al. AngioJet pharmacomechanical thrombectomy and catheter directed thrombolysis vs. catheter directed thrombolysis alone for the treatment of iliofemoral deep vein thrombosis: a single centre retrospective cohort study. Eur J Vasc Endovasc Surg, 2020, 60(4): 578-585.
25. 徐葉亮. 下肢深靜脈血栓形成后綜合征危險因素及預防策略的研究進展. 臨床醫學進展, 2024, 14(2): 2426-2433.
26. 國際血管聯盟中國分部護理專業委員會. 周圍血管血栓性疾病置管溶栓護理專家共識. 介入放射學雜志, 2022, 31(11): 1045-1051.
27. 吳學君, 金星, 郭培明, 等. 下肢深靜脈血栓后綜合征預防措施的臨床研究. 中國普通外科雜志, 2006, 15(5): 338-342.
28. 曾祥熙, 譚風美, 裘法祖. 在外科醫療工作中貫徹“二減一保”的體會. 中華外科雜志, 1966, 14(5): 281-283.
29. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
30. 中華醫學會外科學分會, 中華醫學會麻醉學分會. 中國加速康復外科臨床實踐指南(2021版). 中國實用外科雜志, 2021, 41(9): 961-992.
31. 江志偉, 李寧黎介壽. 應用快速康復外科理念進行胃腸癌手術時的營養管理. 中國臨床腫瘤學教育專輯, 2007: 291-295.
32. 中國研究型醫院學會肝膽胰外科專業委員會. 肝膽胰外科術后加速康復專家共識(2015版). 中華消化外科雜志, 2016, 15(1): 1-6.
33. 中華醫學會外科學分會, 中華醫學會麻醉學分會. 中國加速康復外科臨床實踐指南(2021)(二). 協和醫學雜志, 2021, 12(5): 632-640.
34. Zhang L, Jiang C, Chen Z, et al. Three-year outcomes, risk factors for restenosis after stenting for DVT combined with iliac vein compression syndrome. Clin Appl Thromb Hemost, 2024, 30: 10760296241283821. doi: 10.1177/10760296241283821.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Construction and practice of enhanced recovery after surgery system for treatment of lower extremity deep venous thrombosis

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