经膝下静脉入路行导管溶栓治疗全肢型深静脉血栓形成的临床研究  

Clinical research of catheter-directed thrombolysis for deep vein thrombosis via the below-the-knee access

作　　者：杨心蕊[1] 刘光[1] 施慧华[1] 叶开创[1] 李维敏[1] 刘晓兵[1] 殷敏毅[1] 黄新天[1] 陆民[1] 蒋米尔[1] 陆信武[1] YANG Xin-rui;LIU Guang;SHI Hui-hua;YE Kai-chuang;LI Wei-min;LIU Xiao-bing;YIN Min-yi;HUANG Xin-tian;LU Min;JIANG Mi-er;LU Xin-wu(Department of Vascular Surgery, The Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China)

机构地区：[1]上海交通大学医学院附属第九人民医院血管外科上海交通大学血管病诊治中心,上海200011

出　　处：《中国血管外科杂志（电子版）》2019年第1期20-23,共4页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家自然科学基金项目(81700432);上海市卫生与计划委员会研究项目(201640078);上海九院临床研究助力计划资助(JYLJ019)

摘　　要：目的评估膝下静脉入路治疗全肢型下肢深静脉血栓(DVT)的安全性及有效性。方法回顾性分析2012年1月至2017年1月上海第九人民医院血管外科收治的经膝下静脉入路行接触性导管溶栓(CDT)的74例下肢DVT患者资料,统计溶栓效果、并发症、术后通畅率和血栓形成后综合征(PTS)的发生率。结果 74例患者中,34例在起病3 d内接受CDT治疗,溶栓效果理想;起病4～10 d后接受治疗的患者中有71.0%(22/31)成功达到血栓完全溶解;超过10 d者没有一例达到血栓完全溶解。14例患者出现出血并发症,没有大出血发生;11例穿刺部位麻木不适;2例经小隐静脉入路患者出现局部闭塞;胫后静脉入路患者中有1例出现静脉闭塞。平均随访时间为3.5年(1个月至5年),总体通畅率为85.9%(55/64)。结论对于全肢型DVT的溶栓治疗,膝下静脉入路是一种安全有效的选择。Objective To evaluate the safety and efficacy of below-the-knee (BTK) access in the treatment of entire limb deep vein thrombosis (DVT). Methods Clinical data of 74 patients of acute entire limb DVT treated by consecutive CDT via BTK approach between January 2012 amd January at the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine was analyzed retrospectively. Thrombolysis effect, complications, postoperative patency and incidence rate of post-thrombotic syndrome (PTS) were calculated. Results Among 74 patients, 34 underwent CDT within 3 days of symptom onset and lysis was successful in all cases. In contrast, only 22 (71.0%, 22/31) of those treated within 4 to 10 days and 0 (0%) of those treated after 10 days achieved grade III lysis. A total of 14 bleeding complications occurred, none of which were classified as major, and 11 of which were related to numbness at the site of incision. Two patients treated using a small saphenous vein approach exhibited partial occlusion. One patient treated using a posterior tibial vein approach experienced occlusion. The overall patency rate was 85.9%(55/64) during a mean follow-up duration of 3.5 years(one month to five years). Conclusions The use of BTK approach in entire-limb DVT via small saphenous vein and posterior tibial vein puncture is feasible and safe and may be considered an alternative to traditional CDT approach.

关 键 词：深静脉血栓形成 导管溶栓术 腔内治疗 

分 类 号：R654.4[医药卫生—外科学]