经皮机械血栓清除术联合导管接触性溶栓术治疗急性股青肿的疗效  

Effect of percutaneous mechanical thrombectomy combined with catheter directed thrombolysis on acute femoral bruise

作　　者：文飞[1] 谢锐 孙建明[2] Wen Fei;Xie Rui;Sun Jianming(Department of Vascular Surgery,Ba'nan Hospital Affiliated to Chongqing Medical University,Chongqing 401320,China;Department of Vascular Surgery,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属巴南医院血管外科,重庆401320 [2]重庆医科大学附属第二医院血管外科,重庆400010

出　　处：《血管与腔内血管外科杂志》2022年第7期815-819,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨经皮机械血栓清除术(PMT)联合导管接触性溶栓术(CDT)治疗急性股青肿的疗效和安全性。方法收集2018年1月至2021年4月重庆医科大学附属巴南医院收治的14例青肿患者的临床资料,均进行PMT联合CDT治疗,记录患者的住院时间、尿激酶用量、溶栓时间、术中失血量、并发症发生情况,分析患者的机械吸栓术成功率、血栓清除率、消肿率。结果14例患者均成功行PMT并取得Ⅱ级及以上的血栓清除。平均溶栓时间(1.93±0.59)d,尿激酶用量(95.00±26.66)万单位,溶栓后7例患者合并髂静脉压迫综合征,其中6例置入支架。溶栓后,14例患者下肢肿胀症状明显好转,均取得Ⅲ级血栓清除,平均住院时间(6.00±0.93)d,大腿消肿率(83.09±2.53)%,小腿消肿率(81.47±3.03)%。围手术期除3例穿刺点出血外无其他并发症发生。平均随访(22.86±10.00)个月,2例患者死亡,1例患者血栓复发,1例患者发生轻度深静脉血栓后综合征(PTS),彩色多普勒超声提示12例患者髂股静脉均通畅,但3例患者伴轻度股静脉瓣膜反流。结论PMT联合CDT治疗急性股青肿疗效确切且安全性高,可有效改善患者预后,值得临床推广应用。Objective To investigate the efficacy and safety of percutaneous mechanical thrombectomy(PMT)combined with catheter directed thrombolysis(CDT) in the treatment of acute femoral bruise. Method The clinical data of 14 patients with bruises admitted to Ba’nan Hospital Affiliated to Chongqing Medical University from January 2018 to April 2021 were collected. All patients were treated with PMT combined with CDT. The hospitalization time,urokinase dosage, thrombolysis time, intraoperative blood loss volume, and complications were recorded, the success rate of mechanical thrombectomy, thrombus removal rate, and swelling rate were also analyzed. Result All 14 patients underwent successful PMT and achieved grade Ⅱ or above thrombus removal. The median thrombolysis time was(1.93±0.59) d, and the dosage of urokinase was(95.00±26.66) million units, 7 patients had iliac vein compression syndrome after the thrombolysis, and stents were placed in 6 of them. After thrombolysis, the symptoms of lower extremity swelling in 14 patients were significantly improved, and all patients achieved grade Ⅲ thrombus removal, the average hospitalization time was(6.00±0.93) d, the swelling rate of thigh was(83.09±2.53)%, and the swelling rate of lower leg was(81.47±3.03)%. No other complications was reported during the perioperative period except for 3 cases of puncture point bleeding. During the follow-up(22.86±10.00) months, 2 cases died, 1 case had thrombosis recurrence,1 case developed mild post-thrombotic syndrome(PTS). The color Doppler ultrasound showed that the iliofemoral vein was unobstructed in 12 patients, but 3 patients had mild femoral valvular regurgitation. Conclusion PMT combined with CDT in the treatment of acute femoral bruise is effective and safe. The combined treatment could effectively improve the prognosis of patients, and is worthy of clinical application and promotion.

关 键 词：机械血栓清除 导管接触性溶栓 股青肿 

分 类 号：R543[医药卫生—心血管疾病]