可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢深静脉血栓形成  

Retrievable inferior vena cava filter placement combined with persistent transcatheter thrombolysis for acute deep venous thrombosis of lower extremity

作　　者：王耿[1] 李孝虎[1] 庄佩佩 吴权辉[1] 

机构地区：[1]广东省中山市中医院介入科,528400

出　　处：《介入放射学杂志》2016年第2期171-174,共4页Journal of Interventional Radiology

摘　　要：目的评价可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢深静脉血栓形成(DVT)的安全性和临床效果。方法回顾性分析2012年1月至12月收治的76例急性下肢DVT患者,均在DSA导引下置入下腔静脉滤器,然后置放溶栓导管于血栓段,经导管24 h持续微泵灌注50万U/d尿激酶。根据患者髂股静脉再通情况、住院时间、治疗前后肢体周径差、治愈率、并发症等评估近期疗效和安全性;随访1年,根据患者下肢水肿、髂股静脉闭塞、色素沉着、溃疡等评估远期疗效。结果 76例患者均成功置入下腔静脉滤器(14 d后成功回收71例),治疗14 d后临床症状均不同程度缓解,髂股静脉血流基本或全部恢复,平均住院时间为(6.7±3.1)d。治疗后3、7、14 d肢体周径与治疗前比较明显缩小(P<0.05),治疗期间未出现严重不良反应。下肢静脉彩色超声复查显示,随访6个月时髂股静脉闭塞率和色素沉着率分别为5.3%(4/76)和2.6%(2/76),随访12个月时分别为9.2%(7/76)和7.9%(6/76),未发生皮肤溃疡。结论可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢DVT可取得较好的近远期临床效果,安全可行。Objective To evaluate the safety and efficacy of retrievable inferior vena cava filter placement combined with persistent transcatheter thrombolysis in treating acute deep venous thrombosis （DVT） of lower extremity. Methods The clinical data of 76 patients with acute DVT, who were admitted to authors＇ department during the period from January 2012 to December 2012, were retrospectively analyzed. Under DSA guidance the placement of inferior vena cava filter was performed, then, the thrombolytic catheter was inserted to the thrombus segment. With the help of a micro pump continuous transcatheter infusion of 500 000 U/d urokinase （lasting for 24 hours） was carried out in all patients. Based on the situation of iliac- femoral venous recanalization, the hospitalization time, the preoperative and postoperative limb circumference differences, the cure rate, complications, etc. the short-term effect and safety were evaluated. All patients were followed up for one year. According to lower extremity edema, iliac vein occlusion, pigmentation, ulcer formation, etc. the long-term response was assessed. Results Successful placement of inferior vena cava filter was obtained in all 76 patients, and in 71 patients the filter was successfully retrieved 14 days after its placement. Fourteen days after the treatment, the clinical symptoms became relieved in different degrees, the blood flow of iliac-femoral vein was basically or completely recovered, and the average hospitalization stay was （6.7±3.11） days. At 3, 14, and 7 days after treatment, the limb circumferences were significantly decreased when compared to preoperative ones （P〈0.05）, and no serious adverse reactions occurred during the treatment.Color Doppler ultrasound examination showed that at 6 months after treatment the iliac vein occlusion rate and pigmentation rate were 5.3% （4/76） and 2.6% （2/76） respectively, while at 12 months after treatment the iliac vein occlusion rate and pigmentation rate were 9.2% （7/76） and 7.9% （6/76） res

关 键 词：急性下肢深静脉血栓形成 下腔静脉滤器 导管持续溶栓 

分 类 号：R543.6[医药卫生—心血管疾病]