急性混合型下肢深静脉血栓机械性抽吸与溶栓疗效分析

摘要

Objective: To compare the clinical effect of mechanical aspiration and thrombolytic treatment for acute mixed lower extremity deep venous thrombosis(LEDVT). Materials and Methods: The clinical data of 458 patients with acute mixed LEDVT from April 1998 to January 2010 were reviewed. 327 patients(A group) were treated with mechanical thrombus aspiration, among which there were 113 patients combined with iliac vein compression syndrome(IVCS). PTA and stenting were used as auxiliary treatments, and all the patients received small dose of urokinase (UK) thrombolysis and heparin anticoagulation after operation. 131 patients (B group) were treated by systemic thrombolysis and anticoagulation with UK and heparin. Results: After leaving hospital, the difference of circumference 15 cm above and under the knees for bilateral limbs in group A was reduced from (10.51+7.53) cm and (5.86±3.26) cm to (1.34+1.07) cm and (0.93±0.52) cm(u=21.80, u=27.00). In Group B, the difference was reduced from (10.68±7.67) cm and (5.52±3.37) cm to (2.89±1.53) cm and (1.72±0.89) cm(u=11.39, u=12.45). Patients were followed up for an average of (46 ±39) months, and the circumference 15 cm under the knees was reduced to (0.53±0.42) cm in group A and (1.42+1.35) cm in group B (u=7.40). The sequelae of edema, pigmentation and ulcer were 27.83%(91/327), 13.15%(43/327) and 0% in group A, lower than 55.73%(73/131), 83.97%(110/131) and 9.16%(12/131) in group B (u=3.14, 14.52, 5.58). CDFI found in group A 90.83% veins regained patency and 73.09% valves had normal function, which were higher than those in group B (37.41% and 15.27%, u=12.04, u=11.28). The follow-up effect of group A 88.99% was obviously higher than group B 29.77%(u=12.74). There were two patients in group B who suffered life-threatening bleeding but no one in group A. Conclusion: For the treatment of acute mixed DVT, especially for protecting the normal valve function, mechanical thrombus aspiration is significantly superior to systemic thrombolysis. To prevent re-thrombosis and improve medium-term and long-term follow-up clinical effect, we should take comprehensive treatments of thrombolysis, anticoagulation, antiplatelet etc.%目的:比较机械性血栓抽吸与系统溶栓对急性混合型下肢深静脉血栓形成(LEDVT)的疗效.资料与方法:回顾分析1998年4月-2010年1月458例急性混合型DVT病例的临床资料.机械性血栓抽吸327例(A组),其中合并髂总静脉狭窄或闭塞113例,采取PTA和支架植入辅助处理,术后辅以小剂量尿激酶溶栓、肝素抗凝治疗.系统溶栓131例(B组),均系统性应用尿激酶、肝素,溶栓、抗凝治疗.结果:出院时A组健、患肢膝上、下15 cm处周径差,分别由(10.51±7.53) cm和(5.86±3.26) cm,降为(1.34±1.07) cm和(0.93±0.52) cm,差异有统计学意义(u=21.80和27.00)；B组由(10.68±7.67) cm和(5.52±3.37) cm降为(2.89±1.53) cm和(1.72±0.89) cm,差异有统计学意义(u=11.39和12.45).平均随访(46±39)月,患肢膝下15 cm处周径差降为:A组(0.53±0.42) cm,B组(1.42±1.35) cm,差异有统计学意义(u=7.40).水肿、色素沉着、溃疡等后遗症发生率,A组:27.83％(91/327)、13.15％ (43/327)、0％；低于B组:55.73％(73/131)、83.97％(110/131)、9.16％ (12/131),差异有统计学意义(u=3.14、14.52、5.58).彩超发现,A组静脉通畅率(73.09+17.74)％=90.83％和瓣膜功能正常率(73.09％),均高于B组(15.27+22.14)％=37.41％和15.27％,差异均有统计学意义(u=12.04、11.28).A组随访疗效为优(88.99％)显著高于B组(29.77％)(u=12.74).B组治疗中2例因出血而危及生命,而A组无一例.结论:机械性血栓抽吸对急性混合型LEDVT的疗效,均好于系统溶栓,尤其在保护静脉瓣膜功能方面明显优于溶栓；但不是血栓清除的单一手段,应辅以溶栓、抗凝、祛聚等综合治疗,才能防止血栓再形成和提高中、远期疗效.