多种介入技术联合治疗急性下肢深静脉血栓形成  

Multiple interventional technology therapy for acute lower extremity deep venous thrombosis

作　　者：张希全[1] 王义平[1] 潘晶晶[1] 朱伟[1] 李长海[1] 郭锋[1] 董戈[1] 张清[1] 

机构地区：[1]中国人民解放军第一四八中心医院血管科,山东淄博255300

出　　处：《中国现代普通外科进展》2012年第11期850-855,共6页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨多种介入技术联合治疗下肢深静脉血栓形成(LEDVT)的临床效果和应用价值。方法:回顾性分析911例急性LEDVT患者的临床资料,中央型423例单纯取栓,混合型275例取栓加动脉腔内留置导管溶栓,周围型166例单纯导管溶栓;其中中央型和混合型患者在取栓或取栓加腔内溶栓后,213例行经皮腔内血管成形术加支架置入。结果:介入治疗总有效率99.34%(905/911),平均住院7.5d。患肢肿胀、疼痛均于介入治疗后1～2 d内开始消退或减轻。37例并发肺动脉栓塞35例救治成功,2例抢救失败死亡。介入取栓及溶栓效果:Ⅰ级49.18%(448/911);Ⅱ级27.44%(250/911);Ⅲ级22.94%(209/911);IV级0.44%(4/911)。出院时健、患肢膝上、下15 cm处周径差为(1.34±1.07)cm和(0.93±0.52)cm,与入院时比较差异有统计学意义(P<0.05)。疗效随访:术后12个月,优78.55%(714/909),良14.96%(136/909),中6.05%(55/909),差0.44%(4/909);术后36个月,优75.25%(681/905),良14.14%(128/905),中10.61%(96/905),差0。结论:多种介入技术联合治疗LEDVT,能尽早清除静脉腔内血栓,迅速恢复通畅的血流,缩短病程,更大程度上保存静脉瓣功能;创伤小,并发症少,近、中期疗效显著。Objective： To discuss the clinical effect and application value of multiple interventional technology therapy for acute lower extremity deep venous thrombosis（LEDVT）.Methods： The clinical data of 911 patients with acute LEDVT were analysed retrospectively.423 patients of central type were treated by aspirating thrombus only,275 patients of mixed type were treated by aspirating thrombus and artery lumen indwelling catheter,166 patients of peripheral type were simply thrombolysis;Among of them 213 patients were treated by transluminal balloon angioplasty and stent placement.Results： Total effective rate of interventional therapy was 99.56%（907/911）,the average days in hospital was 7.5 days.Tumescence and pain in affected limb disappeared or relieved after interventional therapy for 1-2 days.37 cases with pulmonary embolism which 35 cases were treated successfully and 2 cases death.The effective of interventional thrombectomy and thrombolysis： Grade I 61.03%（556/911）;Grade Ⅱ15.59%（142/911）;Grade Ⅲ 22.94%（209/911）;Grade IV 0.44%（4/911）.The differences of circumference of affected and healthy limbs and the circumference of affected limbs of knees above and below 15cm,the difference had a statistical significance（P0.05）.12 months of postoperation excellent 78.55%（714/909）,good 14.96%（136/909）,medium 6.05%（55/909）,bad 0.44%（4/909）.36 months of postoperation excellent 75.25%（681/905）, good 14.14%（128/905）,medium 10.61%（96/905）,bad 0.Conclusion： Multiple interventional technology therapy for acute lower extremity deep venous thrombosis,can eliminate thrombus from venous cavity earlier,restore the unobstructed flow instantly,preserve the function of venous valve maximumly,having an advantage of minimally invasive,less complications and notable clinical effect of short and medium-term.

关 键 词：深静脉血栓形成 取栓术 腔内溶栓 介入治疗 

分 类 号：R654.4[医药卫生—外科学]