经皮机械吸栓联合导管接触性溶栓治疗急性期下腔静脉滤器相关血栓的疗效分析  

Effect of percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of acute inferior vena cava filter-associated thrombosis

作　　者：姜广伟[1] 张晓宇[1] 董若愚[1] 丁殿柱[1] 牛帅[1] 吕柏楠[1] Jiang Guangwei;Zhang Xiaoyu;Dong Ruoyu;Ding Dianzhu;Niu Shuai;LüBonan(Department of Vascular Surgery,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院血管外科,河北石家庄050051

出　　处：《中国血管外科杂志（电子版）》2023年第1期56-60,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：河北省医学科学研究项目(20190383)。

摘　　要：目的探讨经皮机械吸栓(percutaneous mechanical thrombectomy,PMT)联合导管接触性溶栓(catheter-directed thrombolysis,CDT)治疗急性期下腔静脉滤器相关血栓的疗效与安全性。方法回顾性分析2018~2021年河北省人民医院收治的21例急性期下腔静脉滤器相关血栓患者的临床资料,根据治疗方法不同分为PMT+CDT组(12例)和CDT组(9例),比较两组溶栓时间、尿激酶用量、滤器回收成功率以及治疗前后下腔静脉滤器血栓和血红蛋白的变化。结果PMT+CDT组的溶栓时间、尿激酶用量均低于CDT组,差异有统计学意义(P<0.05)。PMT+CDT组术中吸栓平均出血量为(71.50±13.47)ml。两组治疗后下腔静脉血栓较治疗前均缩小(P<0.05);治疗后PMT+CDT组下腔静脉血栓小于CDT组,差异有统计学意义(P<0.05)。两组治疗前后的血红蛋白比较差异均无统计学意义(P<0.05)。PMT+CDT组患者均成功回收滤器,滤器回收率为100%;CDT组有5例患者成功回收滤器,滤器回收率为55.6%,两组比较差异有统计学意义(P=0.021)。两组均无严重并发症发生。结论PMT联合CDT是治疗急性期下腔静脉滤器相关血栓安全有效的方法,有助于缩短溶栓时间,减少溶栓药物用量,提高滤器回收率。Objective To evaluate the efficacy and safety of percutaneous mechanical thrombectomy(PMT)combined with catheter-directed thrombolysis(CDT)in the treatment of acute inferior vena cava filter-associated thrombosis.Methods The clinical data of 21 patients with acute inferior vena cava filter-associated thrombosis in Hebei General Hospital between 2018 and 2021 were analyzed retrospectively.The patients were divided into the PMT+CDT group(12 cases)and CDT group(9 cases).The thrombolytic time,dosage of urokinase,the rate of filter retrieval,changes of inferior vena cava filter-associated thrombosis and hemoglobin before and after treatment between two groups were compared.Results The thrombolytic time and urokinase dosage in PMT+CDT group were lower than those in CDT group(P<0.05).The average intraoperative blood loss in PMT+CDT group was 71.50±13.47 ml.After treatment,the size of filter-associated thrombosis decreased in both groups(P<0.05),with the PMT+CDT group was smaller than that in the CDT group,and the difference was statistically significant(P<0.05).There was no significant difference in hemoglobin between two groups before and after treatment(P<0.05).All filters in the PMT+CDT group were successfully retrieved with the filter retrieval rate of 100%,while 5 filters in the CDT group were successfully retrieved with the filter retrieval rate of 55.6%,and the difference was statistically significant(P=0.021).There were no serious complications in both groups.Conclusion PMT combined with CDT therapy is a safe and effective method for the treatment of acute inferior vena cava filter-associated thrombosis.It is helpful to shorten the time of thrombolysis,reduce the dosage of thrombolytic drugs,and improve the retrieval rate of filter.

关 键 词：下腔静脉 血栓形成 导管吸栓 导管接触性溶栓 滤器 

分 类 号：R654.4[医药卫生—外科学]