下肢深静脉血栓形成的临床治疗  

Clincal treatment of lower extremity deep venous thrombosis

作　　者：赖俊谕[1] 代远斌[1] 范颖[1] 

机构地区：[1]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《重庆医科大学学报》2007年第10期1087-1090,共4页Journal of Chongqing Medical University

摘　　要：目的:探讨下肢深静脉血栓形成(DVT)的有效治疗方法。方法:回顾性分析近6年来治疗的186例下肢DVT的临床资料。下腔静脉滤器植入116例,其中下腔静脉滤器植入并手术取栓62例,深静脉置管溶栓54例。随机分为3组,置管溶栓组54例,手术取栓组62例,抗凝组70例。结果:149例(80.1%)随访3～72个月,平均40个月。116例滤网均展开良好,有8例出现不同程度的胀痛,l周后逐渐消失,无移位、倾斜和扩张不良。多普勒及下腔静脉造影检查发现2例l8个月后滤器中血栓形成,其他下腔静脉均通畅。溶栓组显效45例,有效6例,无效3例。手术组显效54例,有效6例,无效2例。抗凝组显效13例,有效43例,无效14例。手术组和溶栓组显效率和总有效率无显著性差异(P>0.1),但手术组和溶栓组显效率和总有效率与抗凝组存在显著性差异(P<0.05)。结论:下腔静脉滤器植入能有效预防肺动脉栓塞,但应严格掌握适应证。手术综合治疗是提高疗效和预防下肢DVT后遗症的有效方法。Objective：To investigate the feasible and effective means for the treatment of the lower extremity deep venous thrombosis （DVT）. Methods：The clincal data of 186 cases of lower extremity DVT treated in recent 6 years were analysed retrospectively. Vena cava filters（VCF） were placed in 116 patients,including 62 cases which underwent embolectomy after IVC filter placement. 54 cases underwent intraluminal cathter-directed thrombolysis with urokinase continuous infusion immediately. Results： 149 patients （80.1%） were followed up for 3-72 months with an averge of 40 months. All of the IVC filters were successfully expanded. 8 cases had a little swelling,which disappeared after a week. Occlusion in 2 cases 18 months after the IVC filter placement,others were patent. In thrombolytic group,45 were cured,6 improved,3 ineffective. In operative group,54 were cured,6 improved,2 ineffective. In anticongulation group,13 were cured,43 improved,14 ineffective. The cured rate and the total effective rate in operative group and thrombolytic group is similar （P〉0.05）,but those of the two groups were better than the anticongulation group （P〈0.05）. conclusions：Vena cava filters placement can effectively prevent the formation of pulmonary embolism, but the indication should be strict. Combination of surgery with other therapy is effective in improving the results and preventing the sequela of lower extremity DVT.

关 键 词：深静脉血栓/治疗 下腔静脉滤器植入 溶栓 

分 类 号：R654.4[医药卫生—外科学]