机械性血栓清除术与置管溶栓治疗急性下肢深静脉血栓的短中期疗效对比  

Comparison of short and medium term efficacy of percutaneous mechanical thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep vein thrombosis

作　　者：曾凡祎 潘升权[1] 龙海灯[1] 殷世武[1] 崔建伟 Zeng Fanyi;Pan Shengquan;Long Haideng;Yin Shiwu;Cui Jianwei(Department of Interventional Vascular,the NO.2 People's Hospital of Hefei,Hefei 230000,Anhui,China)

机构地区：[1]合肥市第二人民医院介入血管科,安徽合肥230000

出　　处：《血管与腔内血管外科杂志》2024年第2期191-194,242,共5页Journal of Vascular and Endovascular Surgery

基　　金：安徽省卫生健康科研项目(AHWJ2022c001);合肥市卫生健康应用医学研究项目(Hwk2021zc001)。

摘　　要：目的 探讨机械性血栓清除术(PMT)与置管溶栓术(CDT)治疗急性下肢深静脉血栓(LEDVT)的短中期疗效。方法 收集2019年4月至2021年4月于合肥市第二人民医院就诊的85例急性LEDVT患者的临床资料,按照治疗方法的不同将其分为PMT组(n=37)和CDT组(n=48)。比较两组患者大腿周径差、小腿周径差、尿激酶使用量、溶栓时间,术后出血、血红蛋白尿及血栓形成后综合征(PTS)发生情况。结果 两组患者大腿周径差、小腿周径差比较,差异均无统计学意义(P>0.05)。PMT组患者溶栓时间明显短于CDT组患者,尿激酶使量明显小于CDT组患者,差异均有统计学意义(P<0.01)。两组患者血红蛋白尿、出血/皮下血肿发生率比较,差异均有统计意义(P<0.05)。PMT组患者血栓完全清除率、血栓大部分清除率均高于CDT组患者,差异均有统计学意义(P<0.05)。术后6个月,两组患者PTS程度比较,差异均无统计学意义(P>0.05)。术后12个月,PMT组患者无PTS、轻度PTS比例均小于CDT组患者,差异均有统计学意义(P<0.05)。结论 PMT与CDT血栓清除率相似,PMT在避免短中期发生PTS方面更有优势,PMT溶栓时间短,溶栓药物使用剂量小,缩短了患者的住院时间。Objective To investigate the short and medium term efficacy of percutaneous mechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)in the treatment of acute lower extremity deep vein thrombosis(LEDVT).Method Clinical data of 85 patients with acute LEDVT treated in the NO.2 People's Hospital of Hefei from April 2019 to April 2021 were collected and divided into PMT group(n=37)and CDT group(n=48)according to different treatment methods.The difference of thigh circumference diameter,calf circumference diameter,urokinase usage,thrombolytic time,postoperative bleeding,hemoglobinuria and post-thrombotic syndrome(PTS)were compared between the two groups.Result There were no statistical significance in the differences of thigh circumference and leg circumference between two groups(P>0.05).The thrombolysis time in PMT group was significantly shorter than that in CDT group,and the amount of urokinase was significantly shorter than that in CDT group,the differences were statistically significant (P<0.01). There were statistically significant differences in the incidence of hemoglobinuria, hemorrhage / subcutaneous hematoma between two groups (P<0.05). The total thrombus clearance and majority thrombus clearance in PMT group were higher than those in CDT group, the differences were statistically significant (P<0.05). Six months after surgery, there was no significant difference in PTS degree between the two groups (P>0.05). 12 months after surgery, the proportion of PTS and mild PTS in PMT group were lower those that in CDT group, the differences were statistically significant (P<0.05). Conclusion The thrombus clearance rate of PMT is similar to that of CDT, and PMT has more advantages in avoiding short and medium term PTS. The short thrombolytic time of PMT and the small dose of thrombolytic drugs shorten the hospital stay of patients.

关 键 词：机械性血栓清除术 置管溶栓 深静脉血栓 疗效 

分 类 号：R543[医药卫生—心血管疾病]