Aspirex机械清栓治疗创伤后急性下肢深静脉血栓形成的临床疗效  

Clinical efficacy of the Aspirex mechanical thrombectomy in treatment of iliofemoral deep vein thrombosis after trauma

作　　者：李金勇 刘建龙[1] 刘笑 贾伟[1] 蒋鹏[1] 程志远[1] 张蕴鑫 田晨阳[1] 田轩[1] LI Jinyong;LIU Jianlong;LIU Xiao;JIAWei;JIANG Peng;CHENG Zhiyuan;ZHANG Yunxin;TIAN Chenyang;TIAN Xuan(Department of Vascular Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院血管外科,北京100035

出　　处：《中国普通外科杂志》2022年第6期735-743,共9页China Journal of General Surgery

基　　金：首都卫生发展科研专项基金资助项目(首发2022-2-2074);北京市属医院科研培育基金资助项目(PX2022015)。

摘　　要：背景与目的:下肢深静脉血栓形成(DVT)行早期血栓清除减容可恢复静脉通畅及缓解症状,目前Angio Jet是国内最常用的静脉血栓清除系统,而Aspirex应用较少,本研究探讨Aspirex机械血栓清除治疗在创伤后急性DVT患者中的疗效及安全性。方法:回顾性分析2016年5月-2020年8月在北京积水潭医院血管外科收治的54例创伤后急性DVT患者的病例资料。所有患者行下腔静脉可回收滤器置入术,其中有Dneali 35例(64.8%)、Celect 3例(5.6%)、Cordis 14例(25.9%)、Octoparms及临时滤器(贝朗)各1例(1.9%)。患者创伤经手术及固定治疗后均行彩超检查或造影明确为髂股静脉及下腔静脉血栓形成。其中,22例(40.7%)为髂股静脉血栓、4例(7.4%)为髂及下腔静脉血栓、11例(20.4%)为下腔静脉血栓、17例(31.5%)为股髂静脉及下腔静脉血栓。所有患者在局麻下行经腘静脉或股静途径Straub Aspirex机械血栓清除手术(PMT),术中联合导管取栓(MAT)、导管接触性溶栓(CDT)、髂静脉球囊扩张及髂静脉支架置入术。统计技术成功率、即刻临床成功率(症状缓解率)、围手术期出血发生率及术后滤器取出率。术后随访1年,超声评价目标静脉通畅率及血栓后综合征(PTS)的发生率。结果:54例患者中,3例(5.6%)行单纯机械血栓清除手术,17例(31.5%)行血栓清除联合导管取栓术,3例(5.6%)行血栓清除联合置管溶栓术,18例(33.3%)行血栓清除联合导管取栓及置管溶栓术,12例(22.2%)行血栓清除联合导管取栓及髂静脉球囊扩张术,1例(1.9%)行血栓清除联合导管取栓及支架置入术。技术成功率及即刻临床成功率均为100%。12例(22.2%)血栓Ⅲ级清除,33例(61.1%)为Ⅱ级清除,9例(16.7%)为I级清除,血栓清除成功率为83.3%。围手术期1例(1.9%)出现脑出血,给予停止溶栓及抗凝,2周复查头颅CT见血肿吸收,无后遗症;2例(3.7%)出现鼻出血及穿刺点血肿,给予压迫后缓解,无症状性肺栓塞及�Background and Aims:Early thrombus removal and debulking for deep vein thrombosis(DVT)of the lower extremities can restore venous patency and relieve symptoms.At present,AngioJet is the most commonly used venous thrombus removal system in China,while Aspirex is infrequently used.Therefore,this study was conducted to investigate the efficacy and safety of percutaneous mechanical thrombectomy(PMT)using Straub Aspirex in the treatment of patients with acute lower extremity DVT after trauma.Methods:The clinical data of 54 patients with DVT after trauma treated in the Department of Vascular Surgery of Beijing Jishuitan Hospital from May 2016 to August 2020 were retrospectively analyzed.All patients underwent inferior vena cava retrievable filter implantation,with Dneali in 35 cases(64.8%),Celect in 3 cases(5.6%),Cordis in 14 cases(25.9%),and Octoparms and Tempofilter II in one case(1.9%)each.The iliofmoral and inferior vena cava vein thrombosis in all patients were identified by color ultrasound examination or venography after surgery and fixation for trauma.Among them,22 cases(40.7%)had iliofemoral vein thrombosis,4 cases(7.4%)had iliac and inferior vena cava vein thrombosis,11 cases(20.4%)had inferior vena cava thrombosis,and 17 patients(31.5%)had iliofemoral and inferior vena cava vein thrombosis.All patients underwent Straub Aspirex PMT under local anesthesia via femoral or popliteal vein approach,combined with manual aspiration thrombectomy(MAT),catheter-directed thrombolysis(CDT),balloon dilation,and stent implantation.The technical success rate,immediate clinical success rate(symptom remission rate),perioperative bleeding rate and filter removal rate were calculated.One-year follow-up was performed,and the target venous patency rate and the incidence of post-thrombotic syndrome(PTS)were evaluated by ultrasound.Results:Of the 54 patients,3 cases(5.6%)underwent mechanical thrombosis alone,17 cases(31.5%)underwent manual aspiration thrombectomy,3 cases(5.6%)underwent CDT,18 cases(33.3%)underwent CDT and MAT,12 cas

关 键 词：静脉血栓形成 外伤 血栓切除术 Aspirex静脉抽吸导管 

分 类 号：R654.3[医药卫生—外科学]