经皮机械血栓清除术联合导管接触性溶栓治疗亚急性期下肢深静脉血栓形成患者的疗效及安全性  

Efficacy and safety of percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in patients with subacute lower extremity deep venous thrombosis

作　　者：文飞亚 沈俐萍 陈江龙 黄显莉 Wen Feiya;Shen Liping;Chen Jianglong;Huang Xianli(Department of Vascular Surgery,Zigong First People's Hospital,Zigong 643000,Sichuan,China;Department of Urology,Zigong First People's Hospital,Zigong 643000,Sichuan,China)

机构地区：[1]自贡市第一人民医院血管外科,四川自贡643000 [2]自贡市第一人民医院肾内科,四川自贡643000

出　　处：《血管与腔内血管外科杂志》2023年第8期969-973,1011,共6页Journal of Vascular and Endovascular Surgery

基　　金：2021年度自贡市重点科技计划项目(医科院自有资金引导类)(2021ZCYKY06)。

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(CDT)治疗亚急性期下肢深静脉血栓形成(LEDVT)患者的疗效及安全性。方法收集2018年3月至2021年12月于自贡市第一人民医院就诊的93例亚急性期LEDVT患者的临床资料,按照介入治疗方案不同将其分为联合组(n=59,采用CDT联合PMT治疗)和CDT组(n=34,采用CDT治疗)。比较两组患者的治疗相关指标、疗效相关指标、D-二聚体(D-D)和纤维蛋白原(FIB)水平、并发症发生情况。结果联合组患者溶栓时间、住院时间均短于CDT组患者,尿激酶用量低于CDT组患者,差异均有统计学意义(P﹤0.05)。两组患者使用滤器植入、支架植入、经皮球囊血管成形术PTA患者比例比较,差异均无统计学意义(P﹥0.05)。联合组患者血栓溶解等级≥Ⅲ级比例、血栓清除率、静脉通畅率、瓣膜功能正常率均高于CDT组患者,差异均有统计学意义(P﹤0.05)。治疗前后,两组患者大腿、小腿患健侧周径差比较,差异均无统计学意义(P﹥0.05);治疗6个月后,两组患者大腿、小腿患健侧周径差均低于本组治疗前,差异均有统计学意义(P﹤0.05)。治疗前后,两组患者D-D、FIB水平比较,差异均无统计学意义(P﹥0.05);治疗6个月后,两组患者D-D、FIB水平均低于本组治疗前,差异均有统计学意义(P﹤0.05)。两组患者各并发症发生率比较,差异均无统计学意义(P﹥0.05)。结论PMT联合CDT治疗亚急性期LEDVT,可缩短其溶栓时间并减少尿激酶用量,同时提升血栓清除率、静脉通畅率、瓣膜功能恢复率,有利于促进患者康复,较单用CDT治疗具有明显优势。Objective To study the efficacy and safety of percutaneous mechanical thrombectomy(PMT)combined with catheter-directed thrombolysis(CDT)in the treatment of patients with subacute lower extremity deep venous thrombosis(LEDVT).Method The clinical data of 93 patients with subacute LEDVT in the Zigong First People's Hospital from March 2018 to December 2021 were selected.According to interventional treatment regimens,the patients were divided into combined group(n=59,treated by CDT+PMT)and CDT group(n=34,treated by CDT).The treatment related indexes and efficacy related indexes,levels of D-dimer(D-D)and fibrinogen(FIB)and complications of two groups were compared.Result The thrombolysis time,hospitalization time,dosage of urokinase in combined group were lower than those in CDT group,the differences were statistically significant(P<0.05).There were no statistical differences in the proportion of patients with filter implantation,stent implantation and percutaneous transluminal balloon angioplasty(PTA)between the two groups(P>0.05).The proportion of patients with thrombolysis grade≥Ⅲ,thrombus clearance rate,venous patency rate and normal rates of valve function in combined group were higher than those in CDT group,the differences were statistically significant(P<0.05).There were no significant differences for the circumference difference of thigh and calf in affected versus normal side before and after treatment in two groups(P>0.05).The circumference difference of thigh and calf of the affected versus normal side were significantly reduced at 6 months of treatment in the two groups,the differences were statistically significant(P<0.05).There were no statistical differences for the levels of D-D and FIB between the two groups before and after treatment(P>0.05);the levels of plasma D-D and FIB after 6 months of treatment were decreased in both groups(P<0.05).There were no significant differences for the incidence of complications between the two groups(P>0.05).Conclusion PMT+CDT in the treatment of subacute LEDVT c

关 键 词：下肢深静脉血栓形成 亚急性期 经皮机械血栓清除术 导管接触性溶栓 疗效 安全性 

分 类 号：R543[医药卫生—心血管疾病]