患侧股静脉穿刺在左下肢深静脉血栓介入治疗中的应用  

Application of Affected Side Femoral Vein Puncture in the Intervention Treatment of Left Lower-extremity Deep Venous Thrombosis

作　　者：王彬[1] 王秀平[1] 刘建[1] 姚中强[1] 张岩[1] 李晨[1] 

机构地区：[1]江苏省徐州市第一人民医院介入科,江苏徐州221002

出　　处：《河北医学》2010年第12期1419-1422,共4页Hebei Medicine

摘　　要：目的:探讨采用患侧股静脉穿刺行介入插管溶栓方法治疗左下肢深静脉血栓的可行性。方法:对18例从右股静脉或右颈静脉入路行左髂股静脉插管失败的急性左下肢深静脉血栓患者,采用左侧股静脉顺行法穿刺,成功后将导丝插入至下腔静脉,再从右侧股静脉或右颈静脉穿出后建立导丝轨道,再沿导丝将导管自右向左逆行插入左侧髂股静脉留置溶栓。结果:18例左股静脉穿刺16例获得成功,建立了左右股静脉导丝轨道,并顺利将导管至右股静脉或右颈静脉插入左侧髂股静脉内;经过3-14d导管溶栓后血栓均完全溶解,下肢肿胀消退;在溶栓过程中左侧股静脉穿刺处无明显淤血和血肿发生。结论:对于经右股静脉或右颈静脉入路插管失败的左下肢深静脉血栓患者,采用患侧股静脉入路建立导丝轨道后再插管的方法,成功率高、安全、创伤小,临床应用可行。Objective： To investigate the feasibility of affected side femoral vein puncture in the thrombolysis by interventional catheterization in the treatment of left lower--extremity deep venous thrombosis. Method： 18 cases of acute thrombosis in the left lower--extremity deep veins who failed in left iliac and femoral vein catheterization via the right femoral vein or the right jugular vein underwent antegrade puncture into the left femoral vein. With the successful puncture confirmed by angi- ography, the wire was inserted into the inferior vena cava and was thereafter guided via the right femoral vein or jugular vein to establish wire track. Subsequently, retrograde insertion of the cathe- ter was conducted along the wire from the right to the left into the left iliac and femoral vein for thrombolysis. Result： 16 cases of the 18 cases had successful puncture into the left femoral vein and a wire track was established between the left and right femoral veins, and the catheter was smoothly inserted into the left iliac and femoral vein via the right femoral vein or jugular vein; 3 to 14 days af- ter catheter thrombolysis, thrombosis was completely dissolved, and lower--extremity swelling subsided; In the course of thrombolysis, no obvious congestion or hematoma occurred at the site of puncture into the left femoral vein. Conclusion： For the patients with left lower extremity deep vein thrombosis who had failed intubation via the right femoral vein or right jugular vein, the establish- ment of wire track with affected side femoral vein approach prior to catheterization in this study is feasible in clinical application for the higher success rate, greater security and less trauma.

关 键 词：患侧股静脉 穿 刺 左下肢 深静脉血栓 

分 类 号：R543.6[医药卫生—心血管疾病]