亚急性下肢深静脉血栓形成的导管溶栓治疗  

Catheter-directed thrombolysis for deep venous thrombosis of lower extremities

作　　者：官云彪[1] 陈幸生[1] 洪登科[1] 薛明[1] 周亚东[1] 郑学洵 

机构地区：[1]福建医科大学附属协和医院血管外科,福州350001

出　　处：《中国血管外科杂志（电子版）》2015年第3期181-184,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探讨经导管溶栓（CDT）治疗亚急性期下肢深静脉血栓形成（DVT）的临床应用价值。方法 36例亚急性下肢DVT患者均行下腔静脉滤器植入,并在B超引导下经小隐静脉（14例）/腘静脉（22例）穿刺置入溶栓导管至静脉血栓中,术后均局部应用尿激酶溶栓、低分子肝素钙抗凝治疗,后期应用华法林抗凝6~12个月。通过观察治疗前后患、健肢周径差的变化及静脉通畅评分及随访观察深静脉血栓后综合征（PTS）的发生等来评定治疗效果。结果全组患者经CDT治疗后症状均有不同程度改善,溶栓前后患、健侧大腿周径差分别为（4.01±2.23）cm、（1.13±1.00）cm,差异有统计学意义（t=8.09,P〈0.01）;小腿周径差分别为（3.28±1.81）cm、（1.24±1.05）cm,差异有统计学意义（t=8.68,P〈0.01）;静脉通畅评分分别为13.36±4.18及4.64±2.53,两者差异有统计学意义（z=-5.248,P〈0.01）,静脉通畅率为（62.97±19.50）%,完成随访30例,失访6例,随访率83.33%,随访时间6~48个月,5例再发血栓,1例重度PTS（无溃疡）,3例中度PTS,3例轻度PTS,总PTS发生率23%,其余病例无复发DVT及PTS。结论亚急性DVT患者部分可采用CDT取得理想的疗效,减少PTS的发生。Objective To investigate the feasibility of catheter directed thrombolysis for subacute deep venous thrombosis of lower extremities. Methods Thirty-six cases of subacute deep venous thrombosis of lower extremities underwent inferior vena cava filter placement and ultrasound-guided catheter directed thrombolysis via the small saphenous（n=14） / popliteal（n=22） vein. After operation, patients were treated by anticoagulation of low-molecular-weight heparin and then warfarin for 6 to 12 months. The items of the differences of leg circumferences between affected and nomal before and after treatment, the venous patency score and the rate of post-thrombosis syndrome were observed and assessed. Results For all patients,swell of lower extremity relieved.The circumferences between affected and normal thigh before and after the thrombolysis were（4.01 ±2.23）cm,（1.13 ±1.00）cm.（t =8.09,P〈0.01）. The circumferences between affected and normal leg before and after the thrombolysis were（3.28 ±1.81）cm,（1.24 ±1.05）cm,（t =8.68,P〈0.01）.The venous patency score before and after the thrombolysis were（13.36±4.18）,（4.64±2.53）,（z=-5.248,P〈0.01）. The mean rate of venous patency was（62.97±19.50）%. Thirty（83.33%） patients were followed up for6~48 months,and 6 cases were lost.During the follow-up,the recurrent thrombosis occurred in 5 cases. Severe PTS（no ulcer）, moderate PTS and mild PTS occurred in 1, 3 and 3 cases, respectively, and the total incidence of PTS morbidity was 23%. The remaining cases did not develop recurrence DVT and PTS.Conclusion After adequate preoperative assessment of subacute deep venous thrombosis, the catheter directed thrombolysis can be used in some cases to achieve the desired effect, reduce the incidence of PTS.

关 键 词：下肢深静脉血栓形成 亚急性 导管溶栓 治疗结果 

分 类 号：R654.4[医药卫生—外科学]