机械血栓清除系统联合导管接触性溶栓治疗急性髂股深静脉血栓形成的临床疗效  

Clinical efficacy of percutaneous mechanical thrombectomy combined catheter-directed thrombolysis in the treatment of acute iliofemoral deep venous thrombosis

作　　者：刘文江 王兵[1] 牛晓阳[1] 李越 高士钦 丁亚坤 Liu Wenjiang;Wang Bing;Niu Xiaoyang;Li Yue;Gao Shiqin;Ding Yakun(Department of Vascular Surgery,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,He'nan,China)

机构地区：[1]郑州大学第五附属医院血管外科,河南郑州450052

出　　处：《血管与腔内血管外科杂志》2024年第1期108-112,116,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的比较经皮机械血栓切除术(PMT)联合导管接触性溶栓(CDT)与单纯CDT治疗急性髂股深静脉血栓形成(DVT)的临床疗效。方法收集2017年10月至2021年9月郑州大学第五附属医院收治的123例急性髂股DVT患者的临床资料,按照手术方式的不同将患者分为联合组(n=59)和单纯CDT组(n=64)。观察两组患者的技术成功率。比较两组患者的临床疗效,尿激酶用量,治疗前后患侧与健侧膝下10 cm和膝上15 cm处周径差,溶栓时间,住院时间,术后一期靶血管通畅率,术后6、12个月血栓形成后综合征(PTS)发生率及围手术期并发症发生率。结果所有患者手术均取得成功,技术成功率为100%。治疗后,联合组患者的显效率高于单纯CDT组患者,差异有统计学意义(P﹤0.05);联合组患者的尿激酶用量明显少于单纯CDT组患者,差异有统计学意义(P﹤0.01);联合组患者膝下10 cm、膝上15 cm处患侧与健侧的周径差均低于单纯CDT组患者,差异均有统计学意义(P﹤0.05)。治疗后,联合组患者的溶栓时间、住院时间均明显短于单纯CDT组患者,差异均有统计学意义(P﹤0.01)。联合组患者的术后一期靶血管通畅率高于单纯CDT组患者,差异有统计学意义(P﹤0.05)。联合组患者术后6、12个月PTS发生率均低于单纯CDT组,差异均有统计学意义(P﹤0.05)。两组患者的围手术期并发症发生率比较,差异无统计学意义(P﹥0.05)。结论与单纯CDT治疗相比,经皮机械血栓切除术联合CDT治疗急性髂股DVT的临床疗效更好,术后一期靶血管通畅率更高,尿激酶使用量更少,患肢肿胀减退更好,溶栓时间、住院时间更短,术后PTS、围手术期并发症发生率更低。Objective To compare the clinical efficacy of percutaneous mechanical thrombectomy(PMT)combined with catheter-directed thrombolysis(CDT)in the treatment of acute iliofemoral deep venous thrombosis(DVT).Method The clinical data of 123 patients with acute iliofemoral DVT admitted to the Fifth affiliated Hospital of Zhengzhou University from October 2017 to September 2021 were collected.According to the mode of operation,the patients were divided into two groups:combined group(n=59)and simple CDT group(n=64).The technical success rates of two groups of patients was observed.The clinical efficacy,the dosage of urokinase,the circumference difference between the healthy side and the affected side at 10 cm below the knee and 15 cm above the knee before and after treatment,thrombolytic time,hospital stay,patency rate of target vessels of first postoperative stage,incidence of PTS at 6 and 12 months after surgery and incidence of perioperative complications were compared between the two groups.Result All patients underwent surgery successfully,and technical success rate was 100%.After treatment,the markedly effective rate in the combined group was higher than that in the simple CDT group(P<0.05);the dosage of urokinase in the combined group was significant less than that in the simple CDT group(P<0.01);the circumference difference between the healthy side and the affected side at 10 cm below the knee and 15 cm above the knee in combined group was all lower than those in the simple CDT group(P<0.05).After treatment,the thrombolytic time and hospital stay in the combined group were significantly shorter than those in the simple CDT group(P<0.01).The patency rate of first postoperative stage of the combined group was higher than that of the simple CDT group(P<0.05).The incidence of PTS at 6 and 12 months after surgery in the combined group were lower than those in the simple group(P<0.05).There was no statistically significant difference in the incidence of perioperative complications between the two groups of patients(P>0.0

关 键 词：经皮机械血栓切除术 导管接触性溶栓 髂股深静脉血栓形成 血栓形成后综合征 

分 类 号：R543[医药卫生—心血管疾病]