不同入路置管溶栓治疗急性下肢深静脉血栓形成

摘要

Objective To evaluate the therapeutic effect of catheter-directed thrombolysis (CDT) for the treatment of acute deep venous thrombosis (DVT) of the lower extremity.Methods Clinical data of 195 patients of acute DVT treated by CDT and adjunctive angioplasty and stenting from August 2010 to February 2014 were analyzed retrospectively.CDT by antegrade puncture of popliteal vein,CDT by great saphenous vein and CDT by retrograde puncture of contralateral femoral vein were used in these cases.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Results Technique success rate,clinical success rate,in popliteal vein group,great saphenous vein group and contralateral femoral vein group were 94.6％,72.2％ and 90.3％,97.3％,83.3％,and 90.0％.Patent rate of deep venous,patent rate of stenting and mild post-thrombotic syndrome (PTS) rate were 88.6％,66.7％ and 75.0％,83.3％,57.1％ and 88.9％,8.3％,26.7％ and 20.8％.Conclusion CDT by antegrade puncture of popliteal vein group combined with adjunctive angioplasty and stenting is safe and effective with higher clinical success rate and better long term results than other approaches for the treatment of DVT patients.%目的 总结不同入路置管溶栓(catheter-directed thrombolysis,CDT)治疗急性下肢深静脉血栓(deep venous thrombosis,DVT)的经验和体会.方法 回顾性分析2010年8月至2014年2月上海长海医院收治的195例病程＜14d的急性下肢DVT患者的临床资料,根据置管方式,分为腘静脉组,大隐静脉组,对侧股静脉组,配合支架成形术,通过回顾术中造影计算血栓溶解率及随访方症状改善来评价静脉再通效果.结果 腘静脉组、大隐静脉组、对侧股静脉组的技术成功率分别为94.6％、72.2％和90.3％;临床成功率分别为97.3％、83.3％和90.0％;随访中,深静脉通畅率分别为88.6％、66.7％和75.0％;支架通畅率分别为83.3％、57.1％和88.9％;轻中度血栓后综合征发生率分别为8.3％、26.7％和20.8％.结论 超声引导下腘静脉置管溶栓治疗急性下肢深静脉血栓形成是安全可靠的方法,临床成功率高,远期效果好.