不同机械血栓清除系统治疗下肢深静脉血栓形成合并髂静脉压迫综合征的临床疗效对比研究  

Clinical efficacy comparative study of different mechanical thrombus clearing system in the treatment of lower extremity deep venous thrombosis combined with iliac vein compression syndrome

作　　者：张蕴鑫 贾伟 蒋鹏 程志远 刘建龙 Zhang Yunxin;Jia Wei;Jiang Peng;Cheng Zhiyuan;Liu Jianlong(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：《血管与腔内血管外科杂志》2025年第2期145-149,154,共6页Journal of Vascular and Endovascular Surgery

基　　金：院级医工企交叉培育项目(YGQ-202405);教育部中国高校产学研创新基金(2023GY041);北京大学医学部教育教学研究课题(2022YB15)。

摘　　要：目的探讨不同机械血栓清除系统治疗下肢深静脉血栓形成(LDVT)合并髂静脉压迫综合征(IVCS)的临床疗效。方法收集2022年7月至2024年7月首都医科大学附属北京积水潭医院收治的60例LDVT合并IVCS患者的临床资料,根据不同的方式分为A组(采用AngioJet机械血栓清除系统)和B组(采用AcoStream机械血栓清除系统)组,每组30例。比较两组患者的血栓清除率、肢体周径差、凝血指标[血红蛋白(Hb)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平、D-二聚体(D-D)水平]、术后并发症发生情况,随访观察术后3个月的复发率。结果两组患者的血栓清除率等级比较,差异无统计学意义(P﹥0.05)。A组患者的血栓抽吸时间短于B组患者,术中失血量少于B组患者,尿激酶总剂量多于B组患者,差异均有统计学意义(P﹤0.05)。术后,两组患者的大腿周径差和小腿周径差均较本组术前降低,差异均有统计学意义(P﹤0.05);术后,两组患者大腿周径差和小腿周径差比较,差异均无统计学意义(P﹥0.05)。术后,两组患者的Hb、D-D水平均较术前降低,PT较术前延长,FIB水平较术前升高,差异均有统计学意义(P﹤0.05);术后,两组患者的Hb水平、PT、FIB水平、D-D水平比较,差异均无统计学意义(P﹥0.05)。A组患者血尿的发生率高于B组患者,差异有统计学意义(P﹤0.05);两组患者穿刺点红肿、鞘周出血、PTS的发生率及复发率比较,差异均无统计学意义(P﹥0.05)。结论不同机械血栓清除系统治疗LDVT合并IVCS的血栓清除率、复发率效果相当,与AcoStream系统相比,AngioJet系统的血栓清除效率更高,更微创,但其血尿的发生率更高,两者各有优缺点,临床应根据患者个体情况权衡利弊选择适宜的术式。Objective To investigate the clinical efficacy of different mechanical thrombus clearing systems in the treatment of lower extremity deep venous thrombosis(LDVT)combined with iliac vein compression syndrome(IVCS).Method The clinical data of 60 patients with LDVT combined with IVCS admitted to Beijing Jishuitan Hospital,Capital Medical University from July 2022 to July 2024 were collected,and the patients divided were into group A(using AngioJet mechanical thrombus clearing system)and group B(using AcoStream mechanical thrombus clearing system)according to different methods,with 30 patients in each group.The thrombus clearance rate,extremity circumference difference,coagulation indicators[hemoglobin(Hb)level,prothrombin time(PT),fibrinogen(FIB)level,D-dimer(D-D)level],and incidence of postoperative complications were compared between two groups of patients,and the recurrence rate of two groups of patients at 3 months after surgery were followed up and observed.Result The comparison of thrombus clearance rates between the two groups of patients showed no statistically significant difference(P>0.05).The thrombus aspiration time of group A patients was shorter than that of group B patients,the intraoperative blood loss was less than that of group B patients,and the total dose of urokinase was higher than that of group B patients,the differences were statistically significant(P<0.05).After surgery,the difference in thigh circumference and calf circumference between the two groups of patients decreased compared to before surgery,and the differences were statistically significant(P<0.05);after surgery,there were no statistically significant difference in the difference of thigh circumference and calf circumference between the two groups of patients(P>0.05).After surgery,the Hb and D-D levels of both groups of patients decreased compared to preoperative levels,PT prolonged compared to preoperative levels,and FIB levels increased compared to preoperative levels,with statistically significant differences(P<0.05);after surg

关 键 词：机械血栓清除系统 下肢深静脉血栓形成 髂静脉压迫综合征 临床疗效 

分 类 号：R543[医药卫生—心血管疾病]