超声引导下的3种入路置管溶栓方案治疗混合性下肢深静脉血栓的疗效比较  

Comparison of efficacies of three approaches for catheterization thrombolytic scheme under ultrasound guidance in treatment of mixed lower extremity DVT

作　　者：王丽萍[1] 冯江毅 郭轶[1] 胡淞 WANG Liping;FENG Jiangyi;GUO Yi;HU Song(Department of General Surgery,Affiliated Central Hospital of Chongqing University,Chongqing 400014,China)

机构地区：[1]重庆大学附属中心医院普外科,400014

出　　处：《重庆医学》2022年第1期97-101,共5页Chongqing medicine

基　　金：重庆市自然科学基金面上项目(cstc2020jcyj-msxmX0645)。

摘　　要：目的探究超声引导健侧股静脉、患侧腘静脉及胫后静脉置管溶栓(CDT)方案治疗混合性下肢深静脉血栓形成(DVT)的疗效,了解其优缺点。方法回顾性分析2019年1月至2020年12月该院收治的111例混合性下肢DVT患者的临床资料,经超声检查结果判定,按不同治疗方式分为A、B和C 3组,每组37例。A组经健侧股静脉CDT治疗,B组经患侧腘静脉CDT治疗,C组经胫后静脉CDT治疗。比较3组患者血栓清除效果、静脉畅通情况(Porter评分)、肢体消肿效果、并发症发生情况等。结果B、C组患者血栓清除效果明显优于A组,差异有统计学意义(P<0.05);B、C组患者血栓清除效果比较,差异无统计学意义(P>0.05)。3组患者术后Porter评分均较术前明显下降,且B、C组患者术后Porter评分均明显低于A组,静脉通畅率明显高于A组,差异均有统计学意义(P<0.05);B、C组患者术后Porter评分、静脉畅通率比较,差异均无统计学意义(P>0.05)。3组患者术后大、小腿周径差均较术前明显下降,且B、C组患者术后小腿周径差明显小于A组,小腿消肿率明显高于A组,C组患者术后小腿周径差明显小于B组,小腿消肿率明显高于B组,差异均有统计学意义(P<0.05);3组患者术后大腿周径差、大腿消肿率比较,差异均无统计学意义(P>0.05)。3组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论超声引导胫后静脉CDT治疗方案溶栓效果较好,可作为DVT首选治疗方法。Objective To investigate the efficacy of ultrasound-guided catheter-directed thrombolysis(CDT)via the healthy side femoral vein,affected side popliteal vein and posterior tibial vein in the treatment of mixed lower extremity deep venous thrombosis(DVT),and to understand their advantages and disadvantages.Methods The clinical data of 111 patients with mixed lower extremity DVT treated in this hospital from January 2019 to December 2020 were retrospectively analyzed.The patients were judged by ultrasound examination results and divided into the group A,B and C according to different treatment modes,37 cases in each group.The CDT therapy was performed via the healthy side femoral vein in the group A,via the affected side popliteal vein in the group B and posterior tibial vein in the group C.The effects of thrombus removal,venous patency(Porter score),subsidence effect of limbs and trunk swelling and the complications occurrence were compared among the three groups.Results The thrombus removal effect in the group B and C was significantly better than that in the group A,and the difference was statistically signi8ficant(P<0.05);the thrombus removal effect showed no statistically significant difference between the group B and C(P>0.05).The postoperative Porter score in 3 groups was significantly decreased compare with before operation(P<0.05),moreover the postoperative Porter score in the group B and C was significantly lower than that in the group A,the venous patency rate was significantly higher than that in the group A,and the differences were statistically significant(P<0.05),while the Porter score and venous patency rate had no statistical difference between the group B and C(P>0.05).The thigh and calf circumference difference after operation in 3 groups was significantly declined compared with before operation,moreover the postoperative calf circumference difference in the group B and C was significantly smaller than that in the group A,the subsidence rate of calf swelling was significantly higher than that in t

关 键 词：下肢深静脉血栓形成 置管溶栓治疗 胫后静脉 血栓清除率 

分 类 号：R543.6[医药卫生—心血管疾病]