Aspirex血栓抽吸术联合置管溶栓治疗下肢深静脉血栓的临床研究  

Aspirex Endovascular Thrombectomy Combined with Catheter-directed Thrombolysis in the Treatment of Lower Extremity Deep Vein Thrombosis

作　　者：郑枫 吴世勇[1] 蔡佳霖 陈宁恒[1] 张闯[1] 张秀丽[1] 郭学利[1] ZHENG Feng;WU Shi-yong;CAI Jia-lin;CHEN Ning-heng;ZHANG Chuang;ZHANG Xiu-li;GUO Xue-li(Department of Vascular Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院血管外科,郑州450052

出　　处：《微循环学杂志》2022年第2期22-28,34,共8页Chinese Journal of Microcirculation

基　　金：河南省卫生健康委,河南省医学科技攻关计划项目(LHGJ20200342);河南省卫生健康委员会,河南省医学科技攻关计划项目(SB201901009);河南省医学科技攻关计划项目(LHGJ20190059)。

摘　　要：目的:探讨Straub Aspirex机械性血栓清除术(PMT)联合导管接触性溶栓治疗(CDT)对下肢深静脉血栓(DVT)的有效性和安全性。方法:回顾性分析郑州大学第一附属医院血管外科2019-01-2021-08期间66例下肢DVT的临床资料,其中采用PMT+CDT联合治疗33例(PMT+CDT组),单纯CDT治疗33例(CDT组)。分别记录两组的肢体消肿率、血栓清除率、并发症、尿激酶应用剂量、住院时间、住院花费以及随访过程中Villalta评分与血栓复发情况等的差异。结果:PMT+CDT组与CDT组的临床成功率无统计学差异(100%vs 93.48%,P>0.05)。术后PMT+CDT组较CDT组大腿消肿率(63.7±19.3%vs 34.7±17.7%)以及小腿消肿率[65.60(47.70-79.20)%vs 42.50(25.00-64.60)%]更高,差异具有统计学意义(P<0.01)。同时PMT+CDT组血栓清除率更高[82.60(75.00-100.00)%vs 65.20(52.70-77.50)%,P<0.01],尿激酶使用量更低[(322.60±244.20)×104U vs(552.00±193.00)×104U,P<0.01],住院时间更短[12.60(11.00-14.50)天vs 15.70(12.00-18.50)天,P<0.05],但住院费用更高[986288.30(3265.30-111681.20)元vs 67301.70(60768.10-79575.70)元,P<0.01]。两组出血事件差异无统计学意义(P>0.05)。在随访期内,PMT+CDT组和CDT组分别有2例和7例发生血栓后综合症(PTS),差异无统计学意义(P>0.05),但PMT+CDT组Villalta评分低于CDT组[1.55(0.50-2.00)分vs 3.09(1.50-4.00)分,P<0.05]。PMT+CDT组再狭窄发生率少于CDT组(0%vs 15.15%,P<0.05)。结论:PMT联合CDT与单纯CDT治疗DVT均具有良好的疗效和安全性。前者在血栓溶解率、肢体消肿率、尿激酶使用量以及住院时间等方面优势明显,再狭窄发生率也更低,值得推广应用。Objective:To assess the efficacy and safety outcomes of percutaneous mechanical thrombectomy(PMT)using Straub Aspirex combined with catheter-directed thrombolysis(CDT)in the treatment of lower extremity deep vein thrombosis(LEDVT),compared with CDT alone.Method:Retrospective review of the clinical data of 66 cases with LEDVT from January 2019 to August 2021,which included 33cases in the PMT+CDT group,and 33 cases in the simple CDT group.The differences in the relief of limb swelling after treatment,thrombus clearance rate,complications,urokinase(UK)dose,hospital stay and costs,and the Villalta score during follow-up were recorded in the two groups were compared.Results:There was no statistical difference in the clinical success rate between group PMT+CDTand group CDT[21 cases(100%)vs.19 cases(93.48%),P>0.05].After treatment,group PMT+CDT had better thigh swelling rate(63.7±19.3%vs.34.7±17.7%)and calf swelling rate[65.60(47.70-79.20)%vs.42.50(25.00-64.60)%]than group CDT,the difference was statistically significant(P<0.01).Compared with group CDT,group PMT+CDT had a higher thrombus clearance rate 82.60[(75.00-100.00)%vs.65.20(52.70-77.50)%,P<0.01],and lower urokinase usage[(322.60±244.20)×104U vs(552.00±193.00)×104U,P<0.01],shorter hospital stay[12.60(11.00-14.50)day vs.15.70(12.00-18.50)day,P<0.05],and higher costs[986288.30(3265.30-111681.20)yuan vs.67301.70(60768.10-79575.70)yuan,P<0.01].Bleeding events were noted in 1 patients and 4 patients in the two groups,and the difference was not statistically significant(P>0.05).During the follow-up period,there were 2 case and 7 cases of post-thrombotic syndrome(PTS)in group PMT+CDT and group CDT respectively.The difference was not statistically significant(P>0.05),but the Villalta score of group PMT+CDT was lower than that of group CDT[1.55(0.50-2.00)vs.3.09(1.50-4.00),P<0.05].The incidence of restenosis in group PMT+CDT was also less than that in group CDT(0%vs.15.15%,P<0.05).Conclusion:Straub Aspirex thrombus combined with CDT and CDT alone have good safety an

关 键 词：下肢深静脉血栓形成 置管溶栓 经皮机械性血栓切除术 

分 类 号：R364.15[医药卫生—病理学]