双向联合溶栓治疗急性混合型下肢深静脉血栓形成的临床疗效  

Clinical Curative Effect of Two Way Combination Thrombolysis Therapy For Acute Mixed Lower Extremity deep venous thrombosis

作　　者：陈国平[1] 顾建平[1] 何旭[1] 楼文胜[1] 陈亮[1] 苏浩波[1] 宋进华[1] 汪涛[1] 施万印[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)介入科,南京210006

出　　处：《临床放射学杂志》2014年第3期421-425,共5页Journal of Clinical Radiology

基　　金：南京市医学科技发展重点项目(编号:ZKX10004);"十二五"南京市医学科技发展重大项目(编号:ZDX12016)

摘　　要：目的 探讨经健侧股静脉穿刺逆行置管溶栓联合经患肢足背浅静脉顺行性溶栓（双向联合溶栓）治疗急性混合型下肢深静脉血栓形成（LEDVT）的临床疗效。方法回顾性分析2010年1月至2012年12月间收治的39例急性LEDVT患者采取双向联合溶栓治疗的临床疗效。结果39例中，经健侧股静脉成功逆行置管溶栓的患者为27例，技术成功率为69．23％（27／39），双向联合溶栓时间为5—10天，平均（7．92±1．24）天。27例患者髂总静脉、髂外静脉、股总静脉、股浅静脉、胭静脉及小腿深静脉段的平均血栓清除率分别为（54．07±28．32）％，（81．11±25．58）％，（82．96±23．17）％，（62．41±25．62）％，（69．44±26．43）％和（47．04±19．48）％。22例患者髂静脉存在不规则狭窄或闭塞，行经皮血管腔内成形术（PTA）和支架置入。出院时髂股静脉主干完全再通、部分再通和闭塞分别为19例（70．37％），4例（14．82％）和4例（14．82％）。临床疗效评价痊愈、有效和无效分别为16例（59．26％）、9例（33．34％）和2例（7．41％）。溶栓期间没有症状性肺动脉栓塞和大出血的发生，发生小的出血并发症3例（11．12％）。结论混合型LEDVT的溶栓治疗尽可能采用逆行置管溶栓快速清除患肢近端血栓，结合PTA和（或）支架置入恢复髂股静脉主干血流，同时联合患肢足背浅静脉顺行性溶栓促使侧支开放，降低静脉压，缓解症状，提高临床治疗效果。Objective To investigate the clinical efficacy of retrograde catheter directed thrombolysis combined with transdorsalis pedis vein anterograde thrombolysis therapy （two way combination thrombolysis therapy） for acute mixed lower extremity deep venous thrombosis （LEDVT）. Methods From January 2010 to December 2012, acute mixed LEDVT were treated with the two ways combination thrombolysis therapy, the thrombolytic effect and clinical curative effect were analyzed retrospectively. Results 39 patients of acute mixed LEDVT were diagnosed between January 2010 and December 2012. The retrograde catheter directed thrombolysis were performed via the contralateral femoral vein in 27 patients, the technique succeed rate was 69.23% （27/39）. The two way combination thrombolysis therapy time was 5 - 10 days, with an average of （7.92±1.24 ） days. The clot lysis rates of iliac vein, external iliac vein, femoral vein, superficial femoral vein, popliteal vein and calf deep vein segments were （54.07±28.32 ） %, （ 81.11±25.58 ） % , （ 82.96±23.17 ） % , （ 62.41±25.62） %, （ 69.44±26.43 ） % and （47.04±19.48） % respectively in 27 patients. The PTA and stent implantation were performed in 22 patients with iliac vein irregular stenosis or occlusion. The iliofemoral vein completely recanalization, partly recanalization and occlusion were occurred in 19 cases （70.37 % ）, 4 cases （ 14.82% ） and 4 cases （ 14.82% ） respectively in the discharge from hospital. The clinical evaluation of recovery, valid and invalid were 16 cases （59.26%）, 9 cases （33.34%） and 2 cases （7.41%）. No symptomatic PE and major bleeding were occurred during the thrombolysis, the small bleeding complications were occurred in 3 cases （11.12% ）. Conclusion The retrograde cathe ter direct thrombolysis are performed to clear the proximal limb thrombosis and recover iliofemoral venous blood stream with PTA or stent implantation for acute mixed LEDVT, and combine with transdorsalis pedis vein anterograde th

关 键 词：深静脉血栓形成 下肢 导管直接溶栓术 治疗 溶栓 

分 类 号：R543.6[医药卫生—心血管疾病]