介入综合治疗急性下肢深静脉血栓形成  

Comprehensive interventional treatment for acute lower limb deep venous thrombosis

作　　者：利峰 柯迪 石明涛 石荣书 LI Feng;KE Di;SHI Mingtao;SHI Rongshu(Department of Interventional,the Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou Province 563003,China)

机构地区：[1]遵义医科大学附属医院介入科,贵州遵义563003

出　　处：《实用放射学杂志》2023年第5期813-816,共4页Journal of Practical Radiology

基　　金：遵义市科技计划项目(遵义科合HZ字[2021]43号,遵义科合HZ字[2022]235号)。

摘　　要：目的探讨介入综合治疗急性下肢深静脉血栓形成(DVT)的临床疗效和安全性。方法回顾性分析143例急性下肢DVT患者的临床资料。所有患者均接受临时下腔静脉滤器(IVCF)植入、手动抽吸血栓清除(MAT)、经导管接触溶栓(CDT)、球囊扩张闭塞/狭窄段或支架植入术治疗。观察并记录血栓清除率、血栓清除过程中出血量、尿激酶(UK)用量、住院时间、手术相关并发症、患肢周径差和髂静脉长期通畅率。结果143例患者成功植入IVCF,138例成功回收,5例未回收。球囊扩张重建髂静脉112例,球囊扩张联合髂静脉支架置入31例。所有患者血栓清除均获临床成功。术中出血量(143.7±8.7)mL。UK用量(266.24±76.56)WU。住院时间(7.9±1.5)d。血尿1例,穿刺部位血肿6例。治疗前后患肢膝关节上、下15 cm周径差为(8.21±1.92)cm和(4.11±2.1)cm。随访6~49个月,平均18个月。21例患者出现血栓后综合征(PTS),单纯球囊扩张组18例(16.0%),球囊扩张联合骼静脉支架植入组3例(9.6%);10例患者出现髂静脉闭塞,单纯球囊扩张组9例(8.0%),球囊扩张联合骼静脉支架植入组1例(3.2%);2组之间无显著性差异(P>0.05)。无失访和死亡病例。结论介入综合治疗急性下肢DVT是一种微创、安全、有效的治疗方法,可长期保持髂静脉通畅,值得推广。Objective To explore the clinical efficacy and safety of comprehensive interventional treatment for acute lower limb deep venous thrombosis(DVT).Methods The clinical data of 143 patients with acute lower limb DVT were analyzed retrospectively.All of them received the comprehensive interventional treatments,including emporary inferior vena cava filter(IVCF)implantation,manual aspiration thrombectomy(MAT),catheter-directed thrombolysis(CDT),balloon dilation of occlusive/narrow segment or stent implantation.The thrombi clearance rate,blood loss during thrombi clearance,urokinase(UK)dosage,hospital stays,operation related complications,circumference difference of affected limb and the long-term patency rate of iliac vein were observed and recorded.Results IVCF were implanted in 143 patients,138 were retrieved,and 5 were not retrieved.There were 112 cases of iliac vein reconstruction with balloon dilation,and 31 cases of balloon dilation combined with iliac vein stent placement.A total of 143 patients with thrombus clearance operation were clinical successfully.The intraoperative blood loss was(143.7±8.7)mL,UK dosage(266.24±76.56)WU and the hospital stays(7.9±1.5)days.Hematuresis was found in one patient and hematomas at the puncture position were found in 6 patients.Before and after treatment,the difference in circumference of 15 cm above and below knee joint of the affected limb was(8.21±1.92)cm and(4.11±2.1)cm,respectively.The mean follow-up was 18(rang,6-49)months.During the follow-up,post-thrombotic syndrome(PTS)was observed in 21 patients,including 18 patients(16.0%)who underwent balloon dilatation alone,and 3 patients(9.6%)with balloon dilatation combined with stent implantation;iliac venous occlusion were observed in 10 patients,including 9 patients(8.0%)who underwent balloon dilatation alone and 1 patient(3.2%)with balloon dilatation combined with stent implantation.There was no significant difference between the two groups(P>0.05).There was no loss to follow-up or death.Conclusion The comprehensive inte

关 键 词：手动抽吸血栓清除 经导管接触溶栓 介入综合治疗 下肢深静脉血栓形成 

分 类 号：R815[医药卫生—放射医学] R543.6[医药卫生—临床医学]