AngioJet装置在左下肢深静脉血栓综合治疗中的临床应用  

Clinical Application of Angiojet Device in the Combined Treatment of Deep Vein Thrombosis of Left Lower Extremity

作　　者：林佳 徐浩 黄瑞 张强 蒋明明 周凡 LIN Jia;XU Hao;HUANG Rui(Department of Interventional Radiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,P.R.China)

机构地区：[1]徐州医科大学附属医院介入放射科

出　　处：《临床放射学杂志》2018年第9期1570-1575,共6页Journal of Clinical Radiology

摘　　要：目的探讨AngioJet机械性血栓清除（PMT）联合置管溶栓（CDT）、滤器置入、球囊扩张及支架置入等综合介入治疗在急性左下肢深静脉血栓（DVT）治疗中的临床应用价值。方法搜集12例经彩色多普勒超声及下肢CT静脉造影（CTV）确诊的左下肢DVT形成患者,经右侧颈内静脉入路行介入治疗。若造影示左髂总静脉无受压、血栓蔓延至下腔静脉或已发生肺栓塞（PE）者置入滤器。术中先采用血栓抽吸治疗,术后均保留导管继续溶栓4~12天。隔日复查造影,若血栓完全溶解并存在左髂静脉受压,则行球囊扩张及（或）支架置入,同时取出滤器。结果 12例患者均行PMT联合CDT治疗,术后造影示左髂股腘静脉血栓清除Ⅲ级11例,Ⅱ级1例。4例置入下腔静脉滤器,9例存在左髂静脉受压,均予球囊扩张,若仍狭窄严重则置入支架,术后滤器均成功取出。12例患者抽吸术中及术后均未出现出血、肾功能衰竭或PE等严重并发症;1例术后出现血红蛋白尿,经对症处理后消失。12例术后随访6~12个月,复查CTV血栓无复发。结论 AngioJet PMT联合CDT、滤器置入、球囊扩张及支架置入治疗急性左下肢DVT是一种微创、安全、有效的治疗方法,值得临床普及。Objective To investigate the clinical value of Angiojet mechanical thrombectomy combined with catheter thrombolysis,filter placement,balloon dilatation and stent implantation in the treatment of acute left lower extremity deep vein thrombosis. Methods 12 patients with left lower extremity deep vein thrombosis,all were diagnosed by CTV and color Doppler ultrasound,and through right jugular vein approach for interventional therapy. If angiography showed left iliac vein thrombosis without compression,thrombus spread to the inferior vena cava or pulmonary embolism,then these patients were treated with filter. During the operation,aspiration was performed first,and the catheter was reserved for thrombolytic therapy for 4-12 d. The angiography was performed every other day. If the thrombus was completely dissolved and there was compression of the left iliac vein,balloon dilatation and stenting were performed and the filter was removed. Results12 patients underwent mechanical thrombectomy combined with thrombolysis therapy,postoperative angiography showed left iliac femoral popliteal vein thrombectomy in 11 cases of grade Ⅲ,grade Ⅱ in 1 case. 4 cases were placed inferior vena cava filter,9 cases suffered compression of the left iliac vein,all were treated with balloon dilatation. If the stenosis was still serious,the stent was inserted and the filters were removed successfully. 12 cases of patients with aspiration,there were no serious complications before and after operation,such as hemorrhage,renal failure,or pulmonary embolism. 1 case of postoperative hemoglobinuria,disappeared after symptomatic treatment. 12 cases were followed up for 6-12 months. There was no recurrence of thrombus on CTV. Conclusion Angiojet thrombus aspiration combined with catheter thrombolysis,filter placement,balloon dilatation and stent placement in the treatment of acute deep vein thrombosis of left lower extremity is a minimally invasive,safe and effective treatment method,worthy of clinical popularization.

关 键 词：AngioJet血栓清除装置 左下肢深静脉血栓 髂静脉受压综合征 介入 

分 类 号：R543.6[医药卫生—心血管疾病]