目的 探讨抗凝溶栓治疗对急性下肢深静脉血栓形成的疗效及其对下肢深静脉血栓形成后综合征(PTS)的发生率及严重程度的影响.方法 回顾性选择2003年3月至2008年12月收治的急性下肢深静脉血栓形成(中央型及混合型)患者共111例(113条肢体).分别采用单纯抗凝(41条肢体)、系统溶栓(27条肢体)或导管溶栓(45条肢体)三种不同治疗方法,在随访期末收集下肢肿胀及静脉冉通情况,使用Villaha及VCSS评分表评判PTS的发生率及严重程度.结果 单纯抗凝组、系统溶栓组和导管溶栓组平均随访时间分别为(41±19)、(52±11)和(26±10)个月.三组PTS的发生率分别为58.5%(24/41)、55.6%(15/27)和35.6%(16/45),其中重度PTS的比例分别为20.8%(5/24)、3/15和1/16;导管溶栓组的PTS发生率和重度PTS比例低于其余两组(P＜0.05).三组患者双下肢周径差较治疗前均有明显改善(P＜0.05);导管溶栓组随访时的大腿周径差为(0.5 4±1.0)cm,小腿周径差为(0.7±1.0)cm,低于其余二组(P＜0.05).长期使用抗凝药物及弹力袜的患者,PTS发生率较低.结论 深静脉血栓形成急性期在抗凝基础上采用导管溶栓治疗,可降低PTS的发生率并减轻其严重程度,明显改善肢体肿胀.辅以规律抗凝及弹力袜支持,可进一步改善疗效.%Objective To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS). Method A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies:anticoagulant group (41 limbs) , thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS. Results The average time of follow-up were (41±19) months in anticoagulant group, (52±1) months in thrombolysis group, and (26 ±10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58. 5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS ( P ＜ 0. 05 ). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0. 5 ±1. 0) cm and (0. 7±1. 0) cm, which were more obvious compared to other two groups (P ＜0. 05).Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant Pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS. Conclusions The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheterdirected thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.
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