非急性下肢深静脉血栓形成置管溶栓治疗63例  

Efficacy of catheter-directed thrombolysis for non-acute deep venous thrombosis of the lower extremity

作　　者：郭松林[1] 周建[1] 袁良喜[1] 包俊敏[1] 景在平[1] 

机构地区：[1]第二军医大学附属长海医院血管外科,上海200433

出　　处：《中华普通外科杂志》2015年第3期235-237,共3页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（81370441）;上海市青年科技启明星计划基金资助项目（13QA1404700）

摘　　要：目的 评价置管溶栓（catheter-directed thrombolysis,CDT）治疗非急性下肢深静脉血栓形成（deep venous thrombosis,DVT）的可行性和疗效. 方法 回顾性分析2009年7月至2013年8月第二军医大学附属长海医院收治的63例病程＞14d的非急性下肢DVT患者采用CDT联合血管成形术治疗的临床资料.通过术前、术后静脉造影计算血栓溶解率来评价静脉再通效果.随访内容包括多普勒超声检测和临床症状、体征的评估.结果 63例患肢平均病程为（22±5）d,采用持续微泵联合脉冲式给药进行溶栓治疗,尿激酶用量为（121±69）万U/d,溶栓时间为（74 ±21）h.血栓显著溶解48（77％）例,15例残留狭窄（＞50％）进行血管成形术,12例植入支架（11例髂静脉,1例股静脉）.溶栓过程无严重并发症,6（10％）例发生轻微出血并发症.平均随访时间（15±6）个月,深静脉通畅率71％ （45/63）,轻中度深静脉血栓形成后综合征（post-thrombotic syndrome,PTS）发生率24％（15/63）,无重度PTS发生.结论 非急性下肢DVT采用CDT联合血管成形术治疗疗效显著、安全,并且可以提高远期深静脉通畅率和降低深静脉血栓形成后综合征（post-thrombotic syndrome,PTS）发生的风险.Objective To evaluate the feasibility and efficacy of catheter-directed thrombolysis （CDT） for the treatment of non-acute （history ＞ 14 days） deep venous thrombosis （DVT） of the lower extremity.Methods Clinical data of 63 patients of non-acute DVT of lower extremities treated by CDT and adjunctive angioplasty and stenting from July 2009 to August 2013 were analyzed retrospectively.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Follow-up was performed by Doppler ultrasound and clinical evaluation.Results A total of 63 limbs with DVT with a mean symptom duration of （22 ± 5） days were treated by a continuous combined with pulse-spray infusion of urokinase of （1.21 ± 0.69） million IU/d for （74 ± 21） hours.Significant recanalization was achieved in 77％ （48 of 63） of the treated limbs.After thrombolysis,percutaneous angioplasty was done for 15 residual lesions and stent placement was performed in 11 iliac veins and 1 femoral vein.Minor bleeding occurred in 6 （10％） patients,no patients suffered from major bleeding or symptomatic pulmonary embolism.During follow up （mean：15 ±6 months）,the veins were patent in 45 （71％） limbs.15 （24％） limbs developed mild post-thrombotic syndrome （PTS）,and none had severe PTS.Conclusions CDT combined with adjunctive angioplasty and stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity DVT.

关 键 词：静脉血栓形成 血管成形术 血栓溶解疗法 支架 

分 类 号：R543.6[医药卫生—心血管疾病]