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

Video：

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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, 韩超, 李荦芸, 等. 加速康复外科(ERAS)理念的由来及发展. 中华医史杂志, 2017, 47(2): 124-127.
2.	陈晨, 魏来. 肝胆胰外科疾病加速康复外科临床路径湖南专家共识(2022版). 中国普通外科杂志, 2022, 31(7): 847-859.
3.	严鹏科, 梅峥嵘, 施胜英, 等. 剖宫产术后快速康复药学服务专家共识. 今日药学, 2023, 33(3): 161-71.
4.	尹健, 王国年, 强万敏, 等. 乳房再造加速康复外科中国专家共识(2022版). 中国肿瘤临床, 2023, 50(8): 379-384.
5.	徐丽丽, 刘序强. 全膝关节置换术后膝关节功能加速康复专家共识. 山东大学学报(医学版), 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, 顾建平. 深静脉血栓形成的个性化抗凝治疗策略. 中国临床研究, 2025, 38(2): 165-168.
8.	中华医学会外科学分会血管外科学组. 腔静脉滤器临床应用指南解读. 中华血管外科杂志, 2019, 4(3): 145-153.
9.	张福先. 腔静脉滤器的规范性应用与并发症的预防. 中国普外基础与临床杂志, 2020, 27(4): 396-399.
10.	黄章伟, 李庆, 唐博. 可回收下腔静脉滤器放置与并发症关系的研究进展. 临床医学进展, 2024, 14(2): 4301-4309.
11.	史振宇, 符伟国. 下肢深静脉血栓清除的现状与进展. 中华血管外科杂志, 2023, 8(2): 170-174.
12.	祖庆佩, 朱吉海. 静脉血栓栓塞症治疗的新进展. 临床医学进展, 2023, 13(6): 10081-10087.
13.	赵得银, 于智勇, 张艮龙, 等. 不同置管入路溶栓治疗急性下肢深静脉血栓形成的应用效果. 实用医学杂志, 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.	张拓, 刘坤, 郭兴友, 等. 导管接触性溶栓与机械血栓清除治疗急性下肢深静脉血栓的临床疗效对比. 中国急救复苏与灾害医学杂志, 2023, 18(10): 1366-1369.
16.	田晨阳, 田轩, 刘建龙, 等. 顺行与逆行入路机械性血栓清除术治疗急性下肢深静脉血栓的前瞻性随机对照研究. 中国普通外科杂志, 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.	许天泽, 李晓强. 髂静脉受压综合征与下肢深静脉血栓形成相关性的研究进展. 中华血管外科杂志, 2021, 6(1): 68-71.
20.	赵渝, 李德卫, 时德, 等. 髂静脉受压综合征的解剖基础. 中国实用外科杂志, 2003, 23(12): 745-746.
21.	陶黎, 朱嵬, 张晓宇, 等. NCE-MRA在评价髂静脉受压分型中的应用价值. 血管与腔内血管外科杂志, 2022, 8(1): 17-21.
22.	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版). 中华普通外科杂志, 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.	徐叶亮. 下肢深静脉血栓形成后综合征危险因素及预防策略的研究进展. 临床医学进展, 2024, 14(2): 2426-2433.
26.	国际血管联盟中国分部护理专业委员会. 周围血管血栓性疾病置管溶栓护理专家共识. 介入放射学杂志, 2022, 31(11): 1045-1051.
27.	吴学君, 金星, 郭培明, 等. 下肢深静脉血栓后综合征预防措施的临床研究. 中国普通外科杂志, 2006, 15(5): 338-342.
28.	曾祥熙, 谭风美, 裘法祖. 在外科医疗工作中贯彻“二减一保”的体会. 中华外科杂志, 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.	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021版). 中国实用外科杂志, 2021, 41(9): 961-992.
31.	江志伟, 李宁黎介寿. 应用快速康复外科理念进行胃肠癌手术时的营养管理. 中国临床肿瘤学教育专辑, 2007: 291-295.
32.	中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识(2015版). 中华消化外科杂志, 2016, 15(1): 1-6.
33.	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(二). 协和医学杂志, 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, 韩超, 李荦芸, 等. 加速康复外科(ERAS)理念的由来及发展. 中华医史杂志, 2017, 47(2): 124-127.
2. 陈晨, 魏来. 肝胆胰外科疾病加速康复外科临床路径湖南专家共识(2022版). 中国普通外科杂志, 2022, 31(7): 847-859.
3. 严鹏科, 梅峥嵘, 施胜英, 等. 剖宫产术后快速康复药学服务专家共识. 今日药学, 2023, 33(3): 161-71.
4. 尹健, 王国年, 强万敏, 等. 乳房再造加速康复外科中国专家共识(2022版). 中国肿瘤临床, 2023, 50(8): 379-384.
5. 徐丽丽, 刘序强. 全膝关节置换术后膝关节功能加速康复专家共识. 山东大学学报(医学版), 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, 顾建平. 深静脉血栓形成的个性化抗凝治疗策略. 中国临床研究, 2025, 38(2): 165-168.
8. 中华医学会外科学分会血管外科学组. 腔静脉滤器临床应用指南解读. 中华血管外科杂志, 2019, 4(3): 145-153.
9. 张福先. 腔静脉滤器的规范性应用与并发症的预防. 中国普外基础与临床杂志, 2020, 27(4): 396-399.
10. 黄章伟, 李庆, 唐博. 可回收下腔静脉滤器放置与并发症关系的研究进展. 临床医学进展, 2024, 14(2): 4301-4309.
11. 史振宇, 符伟国. 下肢深静脉血栓清除的现状与进展. 中华血管外科杂志, 2023, 8(2): 170-174.
12. 祖庆佩, 朱吉海. 静脉血栓栓塞症治疗的新进展. 临床医学进展, 2023, 13(6): 10081-10087.
13. 赵得银, 于智勇, 张艮龙, 等. 不同置管入路溶栓治疗急性下肢深静脉血栓形成的应用效果. 实用医学杂志, 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. 张拓, 刘坤, 郭兴友, 等. 导管接触性溶栓与机械血栓清除治疗急性下肢深静脉血栓的临床疗效对比. 中国急救复苏与灾害医学杂志, 2023, 18(10): 1366-1369.
16. 田晨阳, 田轩, 刘建龙, 等. 顺行与逆行入路机械性血栓清除术治疗急性下肢深静脉血栓的前瞻性随机对照研究. 中国普通外科杂志, 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. 许天泽, 李晓强. 髂静脉受压综合征与下肢深静脉血栓形成相关性的研究进展. 中华血管外科杂志, 2021, 6(1): 68-71.
20. 赵渝, 李德卫, 时德, 等. 髂静脉受压综合征的解剖基础. 中国实用外科杂志, 2003, 23(12): 745-746.
21. 陶黎, 朱嵬, 张晓宇, 等. NCE-MRA在评价髂静脉受压分型中的应用价值. 血管与腔内血管外科杂志, 2022, 8(1): 17-21.
22. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第三版). 中华普通外科杂志, 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. 徐叶亮. 下肢深静脉血栓形成后综合征危险因素及预防策略的研究进展. 临床医学进展, 2024, 14(2): 2426-2433.
26. 国际血管联盟中国分部护理专业委员会. 周围血管血栓性疾病置管溶栓护理专家共识. 介入放射学杂志, 2022, 31(11): 1045-1051.
27. 吴学君, 金星, 郭培明, 等. 下肢深静脉血栓后综合征预防措施的临床研究. 中国普通外科杂志, 2006, 15(5): 338-342.
28. 曾祥熙, 谭风美, 裘法祖. 在外科医疗工作中贯彻“二减一保”的体会. 中华外科杂志, 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. 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021版). 中国实用外科杂志, 2021, 41(9): 961-992.
31. 江志伟, 李宁黎介寿. 应用快速康复外科理念进行胃肠癌手术时的营养管理. 中国临床肿瘤学教育专辑, 2007: 291-295.
32. 中国研究型医院学会肝胆胰外科专业委员会. 肝胆胰外科术后加速康复专家共识(2015版). 中华消化外科杂志, 2016, 15(1): 1-6.
33. 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(二). 协和医学杂志, 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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