Objective To compare the therapeutic effect of ultrasound-guided versus non-guided catheter-directed thrombolysis (CDT) in the treatment of deep venous thrombosis (DVT). Methods A total of 60 patients with DVT were analyzed retrospectively from August 2015 to April 2016 in the Department of Vascular Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University. The patients were divided randomly into two groups: ultrasound-guided CDT (Group A, 30 cases), and non-guided CDT (Group B, 30 cases). Success rate of puncture, length of operation, incidence rate of hematoma, pseudoaneurysms, and arteriovenous fistula at the puncture sites, circumferential diameter difference before and after thrombolysis, venous patency improvement rate, deep vein patency rates and occurrence rates of post thrombotic syndrome (PTS) in long term were evaluated in two groups. Results In group A: the average success rate of puncture was 1 time, average length of operation was (15.4±3.2) minutes, the incidence rate of hematoma at venipuncture sites was 3.33%. Neither pseudoaneurysm nor arteriovenous fistula occurred at the puncture sites. Circumferential diameter difference before and after thrombolysis was (49.47±2.484) mm, venous patency improvement rate of limb was (77.00±2.603)%. The long-term patency rate was 80.0% and the PTS occurrence rate was 10.0%. In group B, the average success rate of puncture was 5.9 times, average length of operation was (30.8±6.6) minutes, the incidence rate of hematoma at venipuncture sites of lower limb was 26.67%. Incidence of pseudoaneurysm and arteriovenous fistula at the puncture sites was 6.67%. Circumferential diameter difference before and after thrombolysis was (28.40±2.856) mm, venous patency improvement rate of limb was (57.23±1.828)%. The long-term patency rate was 46.67% and the PTS occurrence rate was 36.67%. There were significant differences in success rate of puncture, length of opera-tion, incidence of arteriovenous fistula at the puncture sites, circumferential diameter change before and after thrombolysis, venous patency improvement rate, deep vein patency rates and occurrence rates of PTS in long term between two groups ( P<0 . 05 ) . Conclusion The therapeutic effect of ultrasound-guided CDT is better than non-guided and it's worthy of clinical application.%目的 对比超声引导下和无引导置管溶栓治疗急性下肢深静脉血栓形成(DVT)的效果.方法 2015年8月至2016年4月南京大学医学院附属鼓楼医院血管外科收治的60例急性下肢DVT患者,随机分为超声引导下穿刺置管溶栓(A组)和无引导置管溶栓(B组)两组,每组30例,比较两组患者穿刺成功率、手术时间、穿刺部位血肿发生率、假性动脉瘤发生率、动静脉瘘发生率,患肢溶栓前后周径差、静脉通畅改善率,并统计患者远期深静脉通畅率、血栓形成后综合征(PTS)发生率.结果 A组均为1次穿刺成功,平均手术时间(15.4±3.2)分钟,穿刺部位血肿发生率为3.33%,穿刺部位无假性动脉瘤、 动静脉瘘发生;患肢溶栓前后周径差平均(49.47±2.484)mm,静脉通畅改善率(77.00±2.603)%;术后12个月深静脉通畅率80.00%,PTS发生率10.00%.B组平均穿刺成功次数5.9次,平均手术时间(30.8±6.6)分钟,穿刺部位血肿发生率为26.67%,穿刺部位假性动脉瘤和动静脉瘘发生率均为6.67%;患肢溶栓前后周径差平均(28.40±2.856)mm,静脉通畅改善率(57.23±1.8283)%;术后12个月深静脉通畅率46.67%,PTS发生率36.67%.两组在穿刺成功率、手术时间、穿刺部位血肿发生率、患肢溶栓前后周径差、静脉通畅改善率,深静脉通畅率、PTS发生率差异有统计学意义(P<0.05).结论 超声引导下置管溶栓治疗急性下肢DVT的疗效优于无引导置管溶栓,值得临床推广.
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