不同入路导管接触性溶栓治疗联合机械性血栓清除术对下肢急性混合型深部静脉血栓患者的疗效  

Efficacy of Different Approaches of Catheter-Directed Thrombolysis Combined with Percutaneous Mechanical Thrombectomy in Patients with Acute Mixed Lowerextremity Deep Venous Thrombosis

作　　者：胡威龙 张小兵 张同庆 HU Weilong;ZHANG Xiaobing;ZHANG Tongqing(Endovascular Vascular Surgery,Nanyang First People’s Hospital,Nanyang 473000,China)

机构地区：[1]南阳市第一人民医院腔内血管外科,河南南阳473000

出　　处：《河南医学研究》2024年第13期2400-2403,共4页Henan Medical Research

摘　　要：目的探讨不同入路导管接触性溶栓治疗(CDT)联合机械性血栓清除术(PMT)对下肢急性混合型深部静脉血栓患者(LDVT)的疗效及对其D-二聚体(D-D)等指标和预后的影响。方法选取2020年6月至2022年12月南阳市第一人民医院收治的186例急性混合型LDVT患者,根据术式分为两组。其中研究组患者100例,接受经胫前或胫后静脉入路CDT联合PMT治疗,而对照组患者86例,则接受经腘静脉入路CDT联合PMT治疗,比较两组患者的临床疗效。结果研究组的术后静脉通畅率、血栓清除评分及患肢小腿消肿率高于对照组,而其尿激酶总剂量低于对照组,住院时间短于对照组(P<0.05);两组的术后并发症发生率比较,差异无统计学意义(P>0.05);检验相关指标方面,两组术前差异无统计学意义(P>0.05),而两组术后均较术前下降,且研究组变化幅度更甚(P<0.05);术后3个月,研究组的舒适状况量表(GCQ)[6]及血栓形成后综合征(PTS)评分均优于对照组(P<0.05)。结论经胫前或胫后静脉入路PMT联合CDT治疗LDVT患者的效果更佳,同时不增加术后并发症发生率,改善其预后,值得临床推广应用。Objective To investigate the efficacy of different approaches of catheter-directed thrombolysis(CDT)combined with percutaneous mechanical thrombectomy(PMT)in patients with acute mixed lowerextremity deep venous thrombosis(LDVT)and the impact on their D-D and other indicators and prognosis.Methods A total of 186 patients with acute mixed LDVT were selected from Nanyang First People’s Hospital from June 2020 to December 2022 and divided into two groups according to the difference in procedure.One hundred patients in the study group were treated with CDT combined with PMT via the anterior or posterior tibial vein,while 86 patients in the control group were treated with CDT combined with PMT via the popliteal vein.The clinical efficacy and other differences between the two groups were compared.Results The postoperative venous patency rate,thrombus clearance score and swelling reduction rate of the affected calf were obvious higher in the study group than control group,while their total urokinase dose were lower than control group,and hospital stay were shorter than control group(P<0.05).There was no difference in the incidence of postoperative complications between two groups(P>0.05).There was no difference in the preoperative test indicators between two groups(P>0.05),while the postoperative test indicators in both groups were lower than the preoperative ones,more so in the study group(P<0.05).Three months after surgery,the general comfort questionnaire(GCQ)and post thrombotic syndrome(PTS)score in the study group were better than control group(P<0.05).Conclusion PMT combined with CDT via anterior or posterior tibial vein access is more effective in treating patients with LDVT without increasing the incidence of postoperative complications,ultimately improving their prognosis and meriting clinical application.

关 键 词：胫前或胫后静脉入路 下肢深静脉血栓形成 导管接触性溶栓 机械性血栓抽吸 疗效 预后 

分 类 号：R654.4[医药卫生—外科学]