Angiojet改进入路治疗全下肢型急性深静脉血栓形成  

Modified approach improves the clinical efficacy of Angiojet in treatment of whole-lower-limb acute deep vein thrombosis

作　　者：倪其泓[1] 薛冠华[1] 郭相江[1] 杨硕菲[1] 张岚[1] 叶猛[1] NI Qihong;Xue Guanhua;Guo Xiangjiang;Yang Shofei;Zhang Lan;Ye Meng(Department of Vascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院血管外科,200127

出　　处：《中华普通外科杂志》2020年第4期304-308,共5页Chinese Journal of General Surgery

基　　金：上海交通大学医学院附属仁济医院培育基金(PYI1-17-O12)。

摘　　要：目的探讨通过改进入路一期清除腘静脉血栓提高Angiojet机械吸栓治疗全下肢型急性深静脉血栓形成的效果。方法回顾性分析2016年3月至2018年3月31例通过改进穿刺入路对急性全下肢型深静脉血栓形成进行Angiojet机械吸栓治疗患者的临床资料。结果31例患者中,采用对侧股静脉入路26例,另5例采用小腿深静脉入路。29例吸栓前先喷注尿激酶,7例进一步行导管溶栓治疗,26例行骼静脉球囊扩张,14例行骼静脉支架置入,平均住院时间为(7.6±1.8)d,总体血栓清除率Ⅱ级(50%?99%)16例(51.6%)、Ⅲ级(100%)15例(48.4%)。31例患者有30例获得随访,中位随访时间19.7个月,术后12个月一期通畅率为83.3%,血管闭塞的5例患者均发生了不同程度的血栓形成后综合征,发生率为16.7%(5/30)。结论通过改进入路采用机械吸栓治疗全下肢型急性深静脉血栓形成可以一期清除腘静脉血栓,改善流入道血流,血栓形成后综合征的发生率较低。Objective To investigate whether the clinical efficacy of mechanical phannacothronibectomy(PMT)in treatment of whole」ower-limb acute deep vein thrombosis(DVT)could be improved by the modified approach removing popliteal vein thrombosis.Methods From Mar 2016 to Mar 2018,31 patients with whole-lower-limb acute DV T were enrolled and treated with PMT by Angiojet.The clinical data was retrospectively analyzed,and the clinical efficacy was evaluated.Results 26 cases were treated by contralateral common femoral vein approach and the other 5 cases by ipsilateral calf deep vein.Urokinase was given in bolus in 29 patients before thrombectomy.After PMT,7 cases combined with catheter-directed thrombolysis.26 cases underwent iliac vein PTA,and 14 cases underwent iliac vein stenting.The average hospitalization days was(7.6±1.8)d.The thrombus clearance rate was gradeⅡ(50%~99%)in 16 cases(51.6%)and gradeⅢ(100%)in 15 cases(48.4%).30 patients were followed up and the mean follow-up time was 19.7 months.The 12-month primary patency rate was 83.3%.All the 5 patients with occlusion had different degrees of post-thrombotic syndrome(PTS),and the incidence of PTS was 16.7%(5/30).Conclusions The modified approach to treat the whole-lower-limb acute deep vein thrombosis with PMT is safe and effective.The popliteal vein thrombosis can be cleared in one stage.The blood inflow can be improved,and the incidence of PTS is relatively low.

关 键 词：静脉血栓形成 机械溶栓 血栓形成后综合征 

分 类 号：R654.4[医药卫生—外科学]