介入综合治疗在围术期下肢深静脉血栓形成中的临床应用  

Interventional therapy for perioperative deep vein thrombosis of lower extremity

作　　者：邱明科 欧敬民[1] 代玉鑫 王书青[1] 汪洋[1] QIU Mingke;OU Jingmin;DAI Yuxin;WANG Shuqing;WANG Yang(Department of General Surgery,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092

出　　处：《上海医学》2020年第10期605-610,共6页Shanghai Medical Journal

基　　金：上海交通大学转化医学交叉研究基金(ZH2018QNA60)。

摘　　要：目的评价介入综合治疗在围术期下肢深静脉血栓形成(DVT)中的治疗效果。方法收集2015年1月—2018年12月在上海交通大学医学院附属新华医院行介入综合治疗的79例围术期DVT患者的临床资料,男29例、女50例;年龄范围28~80岁,年龄为(55.7±13.6)岁。所有患者均行介入综合治疗。比较治疗前后患肢与健肢大腿、小腿周径差,患肢消肿率。比较治疗后、随访6个月、随访1年时静脉通畅评分、深静脉通畅率。观察介入综合治疗中并发症发生情况,随访期间根据Villalta评分判断有无深静脉血栓形成后综合征(PTS)发生及其严重程度。结果治疗前患肢与健肢大腿、小腿周径差分别为(5.85±1.27)、(4.62±1.23)cm,显著大于治疗后的(1.35±0.73)、(1.22±0.61)cm(P值均<0.01)。大、小腿消肿率分别为(75.08±16.34)%、(70.64±17.45)%。治疗后、随访6个月、随访1年时的深静脉通畅评分分别为(3.46±2.12)、(3.13±2.00)、(3.12±2.56)分,均显著低于治疗前的(13.65±2.81)分(P值均<0.01)。治疗后、随访6个月、随访1年时的深静脉通畅率分别为(73.78±15.9)%、(76.32±15.72)%、(77.07±18.01)%。随访6个月、随访1年时的Villalta评分分别为(2.65±2.33)、(3.13±2.79)分。治疗中有11例患者发生出血事件,发生率为13.92%(11/79)。7例患者出现PTS症状,发生率为8.86%(7/79),但无重症PTS发生。所有患者均获随访,随访时间≥1年,有血栓复发9例(11.39%,9/79),经治疗后临床症状均得到缓解。结论在评估病情和严密监测患者术后病情变化的前提下,以经导管接触性溶栓治疗为主的介入综合治疗围术期DVT的疗效确切,操作简单,并发症少,可在临床广泛运用。Objective To evaluate the effect of interventional therapy on the deep vein thrombosis(DVT)of lower extremity during perioperative period.Methods Clinical data of 79 DVT patients who underwent interventional therapy in our hospital from January 2015 to December 2018 were collected.There were 29 males and 50 females with age of(55.7±13.6)years(range,28-80 years).The circumference differences of the thigh and leg between the affected limb and healthy limb and the detumescence rate of the affected limb were compared before and after treatment.The venous patency score and deep vein patency rate were recorded immediately,6 months and 1 year after treatment.The occurrence and severity of post-thrombotic syndrome(PTS)were evaluated according to Villalta score.Results The circumference differences of the thigh and leg between affected limb and healthy limb before treatment were(5.85±1.27)cm and(4.62±1.23)cm,respectively,which were significantly greater than those after treatment([1.35±0.73]cm and[1.22±0.61]cm,P<0.01).The detumescence rates of the thigh and lower leg were(75.08±16.34)%and(70.64±17.45)%,respectively.The deep vein patency score was 3.46±2.12,3.13±2.00,and 3.12±2.56 immediately,6 months and 1 year after treatment,which were significantly lower than those before treatment(13.65±2.81,P<0.01).The patency rates of deep vein were(73.78±15.9)%,(76.32±15.72)%,and(77.07±18.01)%immediately,6 months and 1 year after treatments,respectivery.The Villalta scores were 2.65±2.33 and 3.13±2.796 months and 1 year after treatment,respectivery.The incidence of bleeding was 13.92%(11/79)in the treatment.Seven patients had PTS(8.86%),but no severe PTS occurred.All patients were followed up over 1 year,and thrombus recurred in 9 patients(11.39%,9/79),which was relieved after treatment.Conclusion Interventional therapy is safe and effective in the treatment of perioperative DVT.It can be widely used on the premise of closely monitoring the changes of patients'condition after operation.

关 键 词：下肢深静脉血栓形成 围术期 导管接触溶栓 下腔静脉滤器置入 

分 类 号：R543.6[医药卫生—心血管疾病]