导管直接溶栓对下肢急性深静脉血栓形成的治疗效果  

Effect of Catheter Directed Thrombolysis on Acute Deep Venous Thrombosis in Lower Extremity

作　　者：侯国峰 卞策[1] 朱广昌[1] 郭巍[1] 马超[1] 汪忠镐[1] 

机构地区：[1]中国人民解放军火箭军总医院心脏大血管外科,北京100088

出　　处：《中国普外基础与临床杂志》2016年第9期1106-1111,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探讨导管直接溶栓（catheter directed thrombolysis，CDT）对下肢急性深静脉血栓形成（acute deep venous thrombosis，ADVT）的治疗效果。方法 回顾性分析笔者所在医院2014年1月至2015年10月期间收治的46例下肢ADVT患者治疗前后的患侧膝上15 cm周径、患侧膝下15 cm周径及通畅改善度评分，分析CDT对下肢ADVT的治疗效果。结果 所有患者均成功置管，其中5例经健侧“翻山”逆行置管，40例在超声引导下经患侧腘静脉顺行置管，1例经患侧股静脉置管。46例患者均成功置管溶栓，溶栓时间3～12 d、（4.7±1.8） d。治疗过程中8例出现不同情况并发症，经对症处理、停药及拔管后均缓解，无死亡。同组内与治疗前比较，全人群、22～45岁组及46～74岁组治疗后患侧的膝上15 cm周径（P=0.028，P=0.017，P=0.031）、膝下15 cm周径（P=0.035，P=0.038，P=0.047）及患侧通畅度评分均较低（P=0.023，P=0.028，P=0.031）；同组内与健侧比较，全人群、22～45岁组及46～74岁组治疗后患侧膝上15 cm周径（P=0.073，P=0.387，P=0.358）和膝下15 cm周径（P=0.416，P=0.625，P=0.253）的差异均无统计学意义。治疗后经超声检查提示血管完全再通15例（32.6%），部分再通28例（60.9%），管腔未通3例（6.5%），总有效率为93.5%（43/46）。出院后有43例患者获访，随访时间1～24个月，中位数为18个月。随访期间，活动后患肢肿胀、皮肤颜色明显加深5例，患肢酸胀明显19例，部分再通者中深静脉血栓形成（DVT）复发9例，发生血栓形成后综合征（PTS）11例。结论 CDT是治疗下肢ADVT最为直接和有效的方法。Objective To explore the effect of catheter directed thrombolysis （CDT） in treatment of acute deep venous thrombosis （ADVT） in lower extremity. Methods Limb circumference at 15 cm above and below the knee at affected side, as well as patency improvement score of 46 patients with ADVT in lower extremity, who received treatment in The Rocket Army General Hospital of PLA between January 2014 and October 2015, were colleted retrospectively, to analyze the effect of CDT in treatment of ADVT in lower extremity. Results All patients were placed catheter successfully, 5 patients were placed catheter by ＇contralateral mountain＇ technique retrograde, 40 patients were placed catheter through the limb popliteal vein at affected side anterograde, guiding by ultrasound, 1 patient was placed catheter through femoral vein at affected side. All of 46 patients got successful thrombolysis, and thrombolysis time was （4.7±1.8） d （3-12 d）. There were 8 patients suffered from complications in different situation, and got treatment of drug withdrawal or tube drawing all ease, no one died. Compared with before CDT treatment in same group, the limb circumference at 15 cm above （P=0.028, P=0.017, P=0.031） and below （P=0.035, P=0.038, P=0.047） the knee at affected side, and patency improvement score （P=0.023, P=0.028, P=0.031） in all patients group, 22-45 years group, and 46-74 years group were all lower after CDT treatment. The limb circumference at 15 cm above （P=0.073, P=0.387, P=0.358） and below （P=0.416, P=0.625, P=0.253） the knee at affected side after CDT treatment were not differed with corresponding indexes of healthy side in the same group of all patients group, 22-45 years group, and 46-74 years group. Ultrasound after treatment showed that, blood vessel recanalization occurred in 15 patients （32.6%）, partial blood vessel recanalization occurred in 28 patients （60.9%）, but thrombus of 3 patients （6.5%） didn＇t removed, the total effective rate was 93.5% （43/46）. Forty thre

关 键 词：急性深静脉血栓形成 导管直接溶栓 下腔静脉滤器 超声引导 

分 类 号：R654.4[医药卫生—外科学]