可回收滤器保护下经导管接触性溶栓治疗急性下肢深静脉血栓初步体会  

Catheter-directed thrombolysis therapy under the retrievable filter protection for acute deep venous thrombosis：initial experience

作　　者：刘源[1] 刘洋[1] 曾伟[1] 张丽峰[1] 林瑶[1] 何春水[1] 

机构地区：[1]成都中医药大学附属医院血管外科·介入治疗中心,四川成都610072

出　　处：《实用放射学杂志》2014年第1期111-115,共5页Journal of Practical Radiology

摘　　要：目的评价采用经患肢远端静脉入路进行经导管接触性溶栓（catheter—directedthrombolysis）治疗急性下肢深静脉血栓（10werextremitydeepvenousthrombosis，LEDVT）的疗效。方法对32例诊断明确的急性LEDVT患者，置入下腔静脉滤器（in—feriorveincavafilter，IVF），经患肢膳静脉或大（小）隐静脉建立静脉入路，在髂、股静脉内留置溶栓导管进行持续接触性溶栓治疗，并造影复查溶栓效果。结果32例患者成功行IVF置入，30例（93．7％）成功行置管溶栓术。溶栓后疗效评价I级24例，Ⅱ级5例，Ⅲ级1例，Ⅳ级0例。术后6d患肢膝关节上、下15cm处周径与术前比较，差异有统计学意义（P％0．01）。结论腔内经导管接触性溶栓术治疗严重急性LEDVT疗效显著，是一种安全、可行的方法。Objective To evaluate the effect of catheter-directed thromholysis treatment via the distal vein in lower extremity for acute lower extremity deep venous thrombosis （LEDVT）. Methods In 32 patients with definite diagnosis of acute LEDVT,throm- bolytic catheters were placed in patients＇ iliac and femoral veins through ipsilateral popliteal veins or distal saphenous veins after im- plantation of inferior vena cava fihers（IVF）. Then, the urokinase was infused into vein cavity continuously via the catheter for thrombolysis. And the thrombolytic efficacy was evaluated by angiography and clinic symptom. Results Thirty-two patients were successfully implanted IVF and catheter-directed thrombolysis procedures were successfully performed in 30 cases （93.7~）. O{ the 30 patients, efficacy in 24 was in grade [ ,5 cases in grade ]I ,1 case in grade 111,0 case in grade IV. Six days after the end of throm- bolysis, the difference of limb circumference above and below the knee 15 cm between before and after thrombolysis was statistically significant （P〈0.01）. Conclusion Intraluminal transcatheter contact thrombolysis treatment for severe acute LEDVT is a safe, feasible method with definite efficacy.

关 键 词：深静脉血栓 溶栓导管 接触性溶栓 下腔静脉滤器 经皮腔内血管成形术 静脉支架 

分 类 号：R543.6[医药卫生—心血管疾病] R815[医药卫生—内科学]