DSA引导下胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成  

DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis

作　　者：刘飒华[1] 肖占祥[1] 戚悠飞[1] 岳劼[1] 陈浩[1] 曾昭凡[1] 李振振[1] 

机构地区：[1]海南省人民医院血管外科,海南海口570311

出　　处：《中国普通外科杂志》2017年第6期758-763,共6页China Journal of General Surgery

摘　　要：目的:初步探讨DSA引导下行胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成(DVT)的疗效。方法:对2012年8月—2016年11月收治的87例混合型及中央型DVT患者行DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗,以术前、术后肢体的周径差以及溶栓后造影深静脉通畅情况评估疗效。结果:87例患者80例穿刺成功(91.9%),其中胫后静脉穿刺成功68例,胫前静脉穿刺成功12例,未穿刺成功7例行胫后静脉切开置管。置管成功后均行碎栓术,并行留置导管溶栓。与溶栓前比较,溶栓后患者小腿周径差明显减小[(4.28±1.02)cmvs.(1.06±0.42cm)],静脉通畅度评分明显降低[(10.25±1.84)vs.1.92±0.5)],差异均有统计学意义(均P<0.05)。结论:DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗下肢DVT是一种简便、有效、疗效确切的方法。Objective： To investigate the efficacy of DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis （DVT）. Methods： From August 2012 to November 2016, 87 patients with mixed type and central type acute lower extremity DVT underwent DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis. Effectiveness evaluation was performed by comparison of the limb circumference differences before and after thrombolysis and observation of the angiographic evidence of deep venous patency after thrombolysis. Results： Of the 87 patients, successful puncture was performed in 80 cases （91.9%）, of whom 68 cases underwent posterior tibial vein puncture and 12 cases underwent anterior tibial vein puncture; 7 cases with failed puncture underwent catheterization by posterior tibial vein incision. Clot fragmentation combined with catheter-directed thrombolysis was performed in all patients after successful catheterization. Compared with findings before thrombolysis, the limb circumference difference was significantly reduced [（4.28±1.02） cm vs. （1.06±0.42） cm] and venous patency score was significantly decreased [（10.25±1.84） vs. （1.92±0.5）], and all differences had statistical significance （all P〈0.05）. Conclusion： DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis is a simple and effective method for treatment of acute lower extremity DVT.

关 键 词：静脉血栓形成 下肢 机械溶栓 血管内操作 

分 类 号：R654.4[医药卫生—外科学]