机械血栓抽吸结合台上溶栓治疗急性下肢深静脉血栓形成  

AngioJet mechanical thrombectomy plus thrombolysis for the treatment of acute deep venous thrombosis of the lower extremity

作　　者：秦锋[1] 李斌本[1] 张雷[1] 张荣杰[1] 陈凯[1] 陆清声[1] 王宏飞[1] 景在平[1] 

机构地区：[1]上海第二军医大学附属长海医院血管外科,200433

出　　处：《中华普通外科杂志》2017年第3期224-227,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金青年项目（81200225）

摘　　要：目的总结机械血栓抽吸＋台上溶栓治疗急性下肢深静脉血栓（deep venous thrombosis，DVT）的经验和体会。方法回顾2013年10月至2015年2月上海长海医院收治急性期下肢DVT患者行AngioJet机械血栓抽吸＋快速溶栓28例病例，通过回顾术中静脉造影计算血栓溶解率及症状改善来评价静脉再通效果。随访内容包括临床症状、体征的评估和下肢深静脉系统多普勒超声检查。结果28例中12例患者放置临时性滤器，平均住院日（3．9±1．1）d，平均手术时间（1．2±0．4）h，台上尿激酶用量（32±12）万u，肝素用量（46±10）mg。血色素平均降低（7．5±2．6）g／L。I级溶解2例（7．1％），后改为传统置管溶栓，Ⅱ级溶解10例（35．7％），m级溶解16例（57．1％），血栓显著再通率即技术成功率为92．9％。2例发生轻微出血并发症。9例患者（32．1％）植入支架。随访至少一年提示深静脉通畅26例（92．9％），支架通畅率为88．9％（1／9），2例（7．1％）出现轻中度血栓后综合征。结论Angio Jet是一种安全有效的机械吸栓装置，较传统深静脉置管溶栓有优势，短期疗效确切。Objective To summary the experience of AngioJet mechanical thrombectomy for the treatment of acute deep venous thrombosis （ DVT ） of lower extremity. Methods Clinical data of 28 patients suffering from acute DVT of lower extremities treated by AngioJet mechanical thrombectomy were analyzed retrospectively from October 2013 to February 2015. 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 Twelve patients were planted temporary vena cava filters. The average length of hospitalization was （ 3.9 ± 1.1 ） days. The average operation time was （ 1.2 ＋ 0. 4 ） hours. The dosage of urokinase was （320 ± 120） × 10^4 U and heparin was （46 ± 10） mg during surgery. The average reduction of hemoglobin was （7.5 ＋ 2.6 ） g/L. Two patients （ Grade [ thrombolysis ） were converted to catheter-directed thrombolysis （CDT）. There were 10 （35. 7% ） cases achieving grade 1I and 16 （57. 1% ） cases achieving grade DI, respectively. Technique success rate were 92. 9%. Minor bleeding events occurred in 2 patients. Nine （ 32. 1% ） patients had stents implanted. One year follow-up found patent deep venous in 26 （92. 9% ） patients and stent patency rate was 88.9% （1/9）. Two （7.1%） cases developed mild postthrombotic syndrome （PTS）. Conclusion AngioJet is a safe and effective tool to treat acute DVT accelerating thrombolytic therapy, and reducing bleeding complications.

关 键 词：静脉血栓形成 血管成形术 机械溶栓 

分 类 号：R654.4[医药卫生—外科学]