支架植入术后导管接触性溶栓治疗髂静脉重度狭窄伴急性深静脉血栓形成  

Catheter-directed thrombolysis after stent implantation for treatment of severe iliac vein stenosis with acute deep venous thrombosis

作　　者：徐一锋 孙一峰 马玉亮 唐黎明 XU Yifeng;SUN Yifeng;MA Yuliang;TANG Liming(School of Medicine, Shaoxing University, Shaoxing 312000, China;Department of Vascular Surgery, Shaoxing People's Hospital, the First Affiliated Hospital of Shaoxing University, Shaoxing 312000, China)

机构地区：[1]绍兴文理学院医学院,浙江绍兴312000 [2]绍兴市人民医院绍兴文理学院附属第一医院血管外科,浙江绍兴312000

出　　处：《中国介入影像与治疗学》2021年第10期603-607,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：浙江省卫生健康科技计划项目(2021KY1134)。

摘　　要：目的观察支架植入术后导管接触性溶栓(CDT)治疗髂静脉重度狭窄伴急性深静脉血栓形成(DVT)的效果。方法对42例髂静脉重度狭窄伴急性DVT行支架植入术联合CDT治疗,对其中22例(观察组)于植入支架后行CDT治疗,20例(对照组)于CDT治疗后植入支架。对比2组尿激酶用量、导管溶栓时间、静脉系统评分、患肢消肿率、并发症及随访情况。结果2组技术成功率均为100%。观察组尿激酶用量和导管溶栓时间均低于对照组(P均<0.05)。术后2组静脉系统评分均较术前降低(P均<0.05),但组间术前及术后评分差异均无统计学意义(P均>0.05)。术后2组患肢(大腿及小腿)消肿率差异均无统计学意义(P均>0.05)。术后4例(观察组、对照组各2例)导管留置部位轻微出血,未见肺栓塞、颅内出血等严重并发症。随访3个月时观察组1例出现左侧小腿肌间静脉血栓,增加利伐沙班剂量至15 mg/d抗凝后复查深静脉超声显示静脉血流通畅;随访6个月时2组髂静脉支架通畅率均为100%。结论支架植入术后CDT治疗髂静脉重度狭窄伴急性DVT安全有效,且相比先溶栓后植入支架可缩短溶栓时间、减少尿激酶用量。Objective To observe the effect of catheter-directed thrombolysis(CDT)after stent implantation for treatment of severe iliac vein stenosis with acute deep venous thrombosis(DVT).Methods Totally 42 severe iliac vein stenosis with acute DVT patients underwent CDT combined with stent implantation,among them 22 patients(observation group)underwent CDT after stent implantation,while other 20(control group)underwent stent implantation after CDT.The dosage of urokinase,time of catheterized thrombolysis,venous system score,deswelling rate of affected limb,complications and follow-up situation were compared between groups.Results The technical success rate was 100%in both groups.The dosage of urokinase and catheter thrombolysis time in observation group were lower than those in control group(both P<0.05).The venous system scores after treatments were lower than those before 2 groups(both P均<0.05),but no significant difference of venous system score before and after treatments was found between groups(all P>0.05).There was no significant difference of postoperative swelling rate of affected limbs(thighs and calves)between groups(both P>0.05).Slight bleeding at the catheter indwelling site was found in 2 of observation group and 2 cases of control group after treatments,while no serious complication such as pulmonary embolism and intracranial hemorrhage occurred.At the end of the third month during following-up,1 patient in observation group developed thrombosis in left calf intermuscular vein,then ultrasound showed smooth venous blood flow after the dose of rivaroxaban was increased to 15 mg/d for anticoagulation.At the end of the sixth month during following-up,the patency rate of iliac vein stents was 100%in both groups.Conclusion CDT after stent implantation was safe and effective for treating severe iliac vein stenosis with acute DVT,which could shorten the thrombolysis time and reduce the dosage of urokinase compared with thrombolysis followed by stent implantation.

关 键 词：髂静脉 静脉血栓形成 下肢 支架 导管接触性溶栓 

分 类 号：R543.6[医药卫生—心血管疾病] R815[医药卫生—内科学]