个体化综合性介入治疗急性下肢深静脉血栓

摘要

Objective To assess the effectiveness of individualized interventional techniques for treatment of acute lower extremity deep venous thrombosis(LEDVT).Methods Inferior vena cava(IVC)filters were implanted in 426 patients with acute LEDVT via the femoral veins from January 2006 to December 2012.The thrombi were then aspirated mechanically in 135 patients with central DVT by inserting 12-14F catheters into the femoral veins of the affected limbs.291 patients with mixed types of LEDVT were treated by combined Fogarty catheter embolectomy and mechanical aspiration through the 12-14F catheters.258 patients with stenosis or occlusion of the common iliac veins underwent percutaneous transluminal angioplasty or stenting.The residual thrombi below the popliteal veins were treated by thrombolytic therapy.Results The procedures were successful in all patients with decreased leg swelling in 1-3 days.The thrombi were completely cleared in 88.97%.The differences in circumferences between healthy and affected limbs at 15 cm above(1.54±0.47)cm and below(0.98±0.41)cm the knees were significantly decreased after treatment(t=19.37, 23.99,P<0.001).The incidences of leg edema,pigmentation and ulceration in 409 patients were 6.85%,2.69% and 0%, respectively in the 3-12 month follow-up.Venous patency rate without mural thrombus was 89.49%on color Doppler imaging with total treatment effectiveness of 98.53%.Conclusion Interventional thrombectomy is safe and effective for treatment of acute LEDVT with high success rate,minimal invasion,shorter hospitalization time and maximum protection of venous valve function.%目的：探讨个体化综合性应用多种介入技术治疗急性下肢深静脉血栓形成的临床疗效和应用价值。方法回顾分析我院自2006年1月～2012年12月间收治的426例急性下肢深静脉血栓形成患者的临床资料，均先经健侧置入下腔静脉滤器。中央型135例，经患侧股静脉插入12～14 F鞘管手动机械性血栓抽吸；混合型291例，采用Fogarty球囊拉栓及12～14 F鞘管手动机械性抽吸血栓联合治疗。258例合并髂总静脉严重狭窄或闭塞的患者，行PTA或支架置入治疗。腘静脉以下血栓行溶栓治疗。结果手术成功率100%，术后1～3 d患肢肿胀、疼痛均开始消退或减轻。血栓完全清除率88.97%；出院时健、患肢膝上、下15 cm处周径差均较术前明显减小（t＝19.37、23.99，P＜0.001）。409例随访3～12个月，水肿、色素沉着、溃疡等后遗症发生率分别为6.85％、2.69％、0％；彩色多普勒超声复查静脉通畅无附壁血栓89.49%；临床总有效率98.53％。结论个体化综合性应用多种介入技术治疗急性下肢深静脉血栓形成，微创、手术成功率及血栓清除率高，且住院周期短，是安全有效的方法。