AngioJet血栓清除联合置管溶栓治疗下肢深静脉血栓形成的疗效分析  

Efficacy analysis of AngioJet thrombectomy combined with catheter directed thrombolysis in treatment of lower extremity deep vein thrombosis

作　　者：康涛[1] 陆耀良[1] 李晓强 韩松[1] 李承龙[3] 翟茂东 KANG Tao;LU Yao-liang;LI Xiao-qiang;HAN Song;LI Cheng-long;ZHAI Mao-dong(Department of Vascular Surgery, The Affiliated Taicang Hospital of Soochow University, Suzhou 215400, China;Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing 210008, China;Department of Vascular Surgery, The Affiliated Second Hospital of Soochow University, Suzhou 215004, China)

机构地区：[1]苏州大学附属太仓医院血管外科,江苏太仓215400 [2]南京大学医学院附属鼓楼医院血管外科,南京210008 [3]苏州大学附属第二医院血管外科,江苏苏州215004

出　　处：《中国血管外科杂志（电子版）》2019年第2期123-127,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：苏州市卫计委临床重点病种诊疗技术专项(LCZX201504);太仓市科技局社会发展面上项目(临床诊疗技术研究)(TC2016SFYL02)

摘　　要：目的评价机械性血栓清除(AngioJet)联合置管溶栓(CDT)治疗下肢深静脉血栓的早中期临床疗效。方法回顾性分析2015年1月至2017年12月苏州大学附属太仓医院血管外科及苏州大学附属第二医院血管外科收治的75例急性下肢深静脉血栓形成患者,分为AngioJet+CDT组(A组,40例)和单纯抗凝组(B组,35例),比较两组治疗后患健侧下肢周径差,静脉通畅度评分及静脉通畅率,随访评价Villalta评分及静脉严重程度评分(VSCC)。结果两组均成功完成治疗。A组治疗后患健侧大腿周径差为(1.45±0.83)cm,小腿周径差为(0.68±0.22)cm,静脉通畅程度评分为(1.2±0.5)分,静脉通畅率为(82.0±5.6)%,B组治疗后患健侧大腿周径差分别(2.68±1.26)cm,小腿周径差为(1.81±0.95)cm,静脉通畅程度评分为(7.8±1.7)分,静脉通畅率为(10.6±7.6)%,差异有统计学意义(P分别=0.018,0.032,0.014,0.008)。两组治疗期间均无死亡,无肺动脉栓塞及严重出血并发症。A组随访1年复发率2.9%(1/35),随访2年Villalta评分为(4.41±2.36)分,VCSS为(7.52±4.46)分,B组随访1年内复发率26.7%(8/30),随访2年Villalta评分为(9.31±1.86)分,VCSS为(12.31±3.79)分;两组复发率、Villalta评分、VCSS比较差异均有统计学意义(P分别=0.036,0.017,0.025)。结论AngioJet血栓清除联合CDT治疗急性下肢深静脉血栓近期疗效安全、有效、微创,近中期疗效满意。Objective To evaluate a the clinical curative effect of AngioJet combined with catheter directed thrombolysis (CDT) in treatment of lower extremity deep vein thrombosis (LEDVT). Methods A retrospective analysis was conducted on 75 patients with acute LEDVT, admitted by the Affiliated Taicang Hospital the Affiliated Second Hospital of Soochow University from January 2015 to December 2017. All patients were divided into 2 groups: AngioJet+CDT group (40 cases, group A) and anticoagulation group (35 cases, group B). The differences in circumferential diameter of the lower limbs, venous patency score, venous patency rate and the Villalta score, venous clinical severity score (VCSS) during the followed up were compared between the two groups. Results Treatment were successfully performed in both groups. In group A, differences in circumferential diameter of healthy thigh was (1.45±0.83) cm, the calf circumference was (0.68±0.22) cm, the venous patency score was (1.2±0.5), and the venous patency rate was (82.0±5.6)% after treatment, while in group B was (2.68±1.26) cm,(1.81±0.95) cm, 7.8±1.7 and (10.6±7.6)%, respectively. The differences were statistically significant between two groups (P=0.018, 0.032, 0.014, 0.008, respectively). There were no deaths as well as pulmonary embolism and severe bleeding complications. In the follow-up of group A, the recurrence rate after one year was 2.9%(1/35);The Villalta score after two years was 4.41±2.36, while the VCSS was 7.52±4.46. The recurrence rate after one year was 26.7%(8/30);The Villalta score after two years was 9.31±1.86 while the VCSS was 12.31±3.79 in Group B. There were significant differences in recurrence rate, Villalta score and VCSS between the two groups (P=0.036, 0.017, 0.025, respectively). Conclusion AngioJet combined with CDT in treatment of LEDVT is a safe, effective, minimally invasive treatment method with a satisfactory result in the short and mid- term.

关 键 词：深静脉血栓形成 机械血栓清除 置管溶栓 

分 类 号：R654.4[医药卫生—外科学]