B超引导下穿刺小隐静脉置管溶栓治疗急性髂股静脉血栓形成

摘要

目的 探讨直接穿刺小隐静脉置管灌注溶栓治疗急性髂股静脉血栓的临床应用价值.方法 急性髂股静脉血栓形成患者19例,其中合并肺动脉栓塞1例,均予行下腔静脉滤器置入后,在B超引导下经小隐静脉穿刺置入灌注溶栓导管至静脉血栓中,以3～4×104 U/h微注泵持续推注尿激酶,尿激酶总用量(439.47±76.065)×104 U,并辅以抗凝治疗,通过观察治疗前后患、健肢周径差的变化及静脉通畅评分来评定治疗效果.结果 全组患者经小隐静脉置管灌注溶栓治疗后,症状均明显改善,其中术前确诊的1例肺动脉栓塞患者治疗结束后症状消失,其余患者术后均未发生肺动脉栓塞.溶栓前后患、健侧大腿周径差分别为(6.47±1.61),(1.21±0.67)cm,差别有统计学意义(t=12.197,P<0.01);小腿周径差分别为(2.95±1.14),(0.58±0.48)cm,差别有统计学意义(t=10.205,P<0.01);静脉通畅评分分别为(15.89±1.05),(2.31±1.16)分,两者差别有统计学意义(z=-3.844,P<0.01);静脉通畅率为(85.26±7.67)%.其中3例出现髂静脉狭窄,程度70%以上甚至闭塞,可见明显侧支循环,行髂静脉支架置入术,术后狭窄消除,血流通畅,侧支明显减少或消失.完成随访18例,失访1例,随访率94.44%,未再发现血栓复发.结论 经小隐静脉穿刺置管溶栓在治疗下肢深静脉血栓形成中具有操作简便,安全性高,不易损伤神经,并发症少,便于护理等优点,值得在临床上推广;在具有适于采用该方法的情况下,均应优先采用该方法.%Objective To evaluate the clinical application of Ultrasound-guided puncture the small saphenous vein catheter thrombolytic therapy for treatment of acute iliofemoral venous thrombosis. Method 19 patients in which 1 patient had pulmonary embolism with acute iliofemoral venous thrombosis underwent inferior vena cava filter placement and ultrasound-guided catheter-directed thrombolysis via the small saphenous vein. Urokinase -was infused under 3～1×101 U/h, the total dosage of urokinase is (439. 47+76. 065)×101 U. The venous patency score and the rate of patency improvement -were observed by venograms before and after therapy. Results In whole patients,lower limb swell and pulmonary symptoms relieved. Pulmonary embolism in one patient complete dissolved. The circumferences bet-ween affected and normal thigh before and after the thrombolysis were(6. 47 + 1. 61), (1. 21+0. 67)cm(t = 12. 197,P<0. 01) ; The circumferences bet-ween affected and normal leg before and after the thrombolysis were(2. 95 + 1. 14), (0. 58 + 0. 48)cm(t=10. 205. P<0. 01). The venous patency score before and after the thrombolysis were(15. 89 + 1. 05) ,(2. 31+1. 16)(z=-3. 844,P<0. 01) , The mean rate of venous patency -was (85. 26 + 7. 67)% , 7 patients -whose common iliac vein -was occluded or stenosis. The extent of stenosis more than 70%, the iliac veins -were patent after the placements of the stent. 18 patients -were followed up for 3~25 months,and 1 case was lost. There were no thrombosis relapses. Conclusion Ultrasound-guided puncture the small saphenous vein catheter thrombolytic therapy for treatment of acute deep venous thrombosis in the lower limb is safe, easy to operate and care, Difficult to damage nerve and with less complication. This method should be recommended for clinic use.