顺行与逆行入路机械性血栓清除术治疗急性下肢深静脉血栓的前瞻性随机对照研究  

Mechanical thrombectomy using anterograde versus retrograde approach for the treatment of acute lower extremity deep vein thrombosis:a prospective randomized controlled study

作　　者：田晨阳 田轩 刘建龙 贾伟 蒋鹏 程志远 张蕴鑫 李金勇 刘笑 周密 华润 TIAN Chenyang;TIAN Xuan;LIU Jianlong;JIA Wei;JIANG Peng;CHENG Zhiyuan;ZHANG Yunxin;LI Jinyong;LIU Xiao;ZHOU Mi;HUA Run(Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院血管外科,北京100035

出　　处：《中国普通外科杂志》2024年第12期1983-1994,共12页China Journal of General Surgery

基　　金：首都卫生发展科研专项基金资助项目(首发2022-2-2074);北京市属医院科研培育基金资助项目(PX2022015);北京积水潭医院“学科骨干”计划专项基金资助项目(XKGG202213)。

摘　　要：背景与目的:急性下肢深静脉血栓形成(DVT)是临床常见疾病,急性期可继发急性肺栓塞(PE)和肢体肿胀,慢性期出现深静脉血栓后综合征(PTS),严重威胁人类的健康。早期行机械血栓清除术可恢复静脉通畅及缓解症状,降低PTS的发生率。AngioJet机械性血栓清除术(PMT)具有血栓清除快速高效、并发症少等优点,临床中获得广泛应用,但对PMT治疗入路选择,国内、外尚无规范化指南推荐。本研究通过比较顺行与逆行入路AngioJet PMT治疗急性下肢DVT的临床效果及对静脉瓣膜功能影响,探讨急性下肢DVT清除手术的合理选择。方法:采用前瞻性随机对照方法,选取2022年1月—2024年6月首都医科大学附属北京积水潭医院血管外科收治的急性下肢DVT患者96例,按照操作与瓣膜开放方向不同分为顺行入路(顺行组)和逆行入路(逆行组),对两组治疗方法的手术效果与手术风险进行评估,并分析影响术后3个月深静脉通畅率的相关因素。结果:最终入组92例患者,其中顺行组47例(51.1%),逆行组45例(48.9%),入组病例均使用AngioJet治疗。两组患者的基线资料差异无统计学意义(均P>0.05)。顺行组滤器血栓拦截14例(29.8%),有效滤器血栓拦截7例(14.9%),4例(8.5%)新发PE或PE加重;逆行组滤器血栓拦截18例(40.0%),有效滤器血栓拦截8例(17.8%),5例(11.1%)新发PE或PE加重,两组间以上指标及其他安全性指标与术后实验室指标差异均无统计学意义(均P>0.05)。顺行组术中手动抽吸血栓比例高于逆行组(68.1%vs.26.7%,P<0.001),顺行组与逆行组血栓Ⅲ级清除率(61.7%vs.68.9%)和3个月深静脉通畅率(93.6%vs.91.1%)及其他围术期指标差异无统计学意义(均P>0.05)。对可能影响两组3个月深静脉通畅率的因素进行回归分析,结果显示,顺行组的即刻静脉通畅率(OR=3.043,95%CI=0.993~1.209)、辐射剂量(OR=0.868,95%CI=-0.001~0.000),逆行组的即刻静脉通畅率(OR=2.333,95%CI=0.655~0.980Background and Aims:Acute lower extremity deep vein thrombosis(DVT)is a common clinical condition.In the acute phase,it can lead to secondary complications such as acute pulmonary embolism(PE)and limb swelling,while in the chronic phase,it may result in post-thrombotic syndrome(PTS),posing significant health risks.Early mechanical thrombectomy can restore venous patency,alleviate symptoms,and reduce the incidence of PTS.AngioJet percutaneous mechanical thrombectomy(PMT)offers the advantages of rapid and efficient thrombectomy with fewer complications,making it widely used in clinical practice.However,there are currently no standardized guidelines at home or abroad regarding the choice of access route for PMT.This study was performed to compare the clinical outcomes and effects on venous valve function of antegrade versus retrograde AngioJet PMT for treating acute lower extremity DVT,aiming to explore the optimal surgical approach for thrombectomy.Methods:A prospective,randomized controlled study was conducted,enrolling 96 patients with acute lower extremity DVT treated at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,from January 2022 to June 2024.Patients were divided into an antegrade group and a retrograde group based on the direction of operation and valve opening.Surgical outcomes and risks were evaluated for both groups,and factors influencing the 3-month postoperative venous patency rate wereanalyzed.Results:A total of 92 patients were finally included,with 47 cases in the antegrade group(51.1%)and 45 cases in the retrograde group(48.9%),all treated with AngioJet PMT.Baseline characteristics showed no significant differences between the two groups(all P>0.05).In the antegrade group,14 cases(29.8%)had thrombus interception by filters,with 7 cases(14.9%)being effective;4 cases(8.5%)developed new or worsened PE.In the retrograde group,18 cases(40.0%)had thrombus interception by filters,with 8 cases(17.8%)being effective;5 cases(11.1%)developed new or worsened PE.No s

关 键 词：静脉血栓形成 下肢深静脉血栓形成 血栓切除术 腔静脉滤器 随机对照试验 

分 类 号：R654.3[医药卫生—外科学]