置管溶栓治疗急性下肢深静脉血栓形成的不同入路分析  

Different methods of catheter-directed thrombolysis for deep venous thrombosis

作　　者：丁洋[1] 万圣云[1] 叶琨[1] 孔令尚[1] 马龙[1] 

机构地区：[1]安徽医科大学第二附属医院血管外科,安徽合肥230601

出　　处：《安徽医药》2017年第7期1228-1231,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨置管溶栓治疗急性深静脉血栓形成的不同入路的优劣。方法回顾性分析56例急性深静脉血栓形成的病人,采用不同入路行置管溶栓治疗,通过手术时间、治疗效果和并发症来评价各种入路治疗的效果。结果病人分为4组:A组(10例,18%)经小隐静脉切开入路,平均手术时间为(30±4)min,1例(10%)切口延迟愈合,2例(20%)切口渗血;B组(29例,52%)经胫后静脉切开入路,平均手术时间为(32±5)min,2例(6.9%)切口延迟愈合,4例(13.8%)切口渗血;C组(15例,27%)经胫前静脉穿刺入路,平均手术时间为(20±3)min,2例(13.3%)误穿入胫前动脉。D组(2例,3%)经健侧股静脉入路,平均手术时间(31±4)min。4组病人治疗前后各组间大腿周径差均差异有统计学意义(χ2=54.5,P<0.05)。4组病人治疗前和治疗后各组间大腿周径差均差异无统计学意义(χ2=5.4,P>0.05)。结论对于不同病人采取个体化治疗,建议首选胫前静脉穿刺入路,为病人提供最大收益和最低风险的理想治疗方式。Objective To explore the advantages and disadvantages of different methods of catheter-directed thrombolysis in the treatment of acute deep venous thrombosis.Methods Retrospective analysis was made of 56 cases of acute deep vein thrombosis;thrombolytic therapy was performed with different approaches.The effect of each treatment was evaluated in the operation time,the efficacy and complications.Results The patients were assigned into four groups.Group A （10 cases,18%） was treated with small saphenous vein incision;the average operation time was （30＆#177;4） min;there were 1 case （10%） of delayed healing,2 cases （20%） of incision bleeding.Group B （29 cases,52%） was treated by posterior tibial vein incision;the average operation time was （32＆#177;5） minutes;there were 2 cases （6.9%） of delayed healing,4 cases （13.8%） of incision bleeding.Group C （15 cases,27%） was treated by anterior tibial vein puncture;the average operation time was （20＆#177;3） minutes;there were 2 cases （13.3%） of posterior tibial vein incision by mistake.Group D （2 cases,3%） was treated with the lateral femoral vein approach;the average operation time was （31＆#177;4） minutes;there was statistically significant difference in the circumference of the lower limbs between preoperation and postoperation（χ2 =54.5,P〈0.05）.There was no statistically significant difference in the circumference among the four groups of patients before and after treatment （χ2 =5.4,P〉 0.05）.Conlusions Individual treatment will be adopted for individual patient.The preferred approach is anterior tibial vein puncture,which can provide patients with the greatest benefits and the minimum risk.

关 键 词：静脉血栓形成 血栓溶解疗法 支架 血管成形术 

分 类 号：R654.4[医药卫生—外科学]