摘要
目的评价急性下肢深静脉血栓(LEDVT)中央和混合型,手动机械性血栓碎吸治疗的中、长期疗效。方法回顾分析1998年4月至2011年10月,745例急性、亚急性LEDVT病例的临床资料。男389例,女356例。年龄23～86岁,平均(58.72±11.95)岁。左下肢465例,右下肢280例。中央型258例占34.63%,混合型487例占65.37%。经健侧股静脉安置下腔静脉滤器,患侧股静脉插入8～14F鞘管手动机械性碎吸血栓。Fogarty球囊导管与血管扩张球囊导管协同,物理性拉栓碎栓,将血栓拉至较集中部位(髂静脉),再用大腔导管手动机械性清除血栓。拉栓前在腔、髂静脉汇合处充胀球囊阻挡回心血流,防血栓脱落随血流进入腔静脉。213例合并髂总静脉狭窄或闭塞,采取PTA和支架植入处理。混合型机械性血栓碎吸术后辅以小剂量尿激酶溶栓、肝素抗凝等综合治疗。结果出院时健、患肢膝上、下15cm处周径差降为:中央型(1.34±1.07)cm和(0.93±0.52)cm,混合型(2.89±1.53)cm和(1.72±0.89)cm;与术前比较差异均有统计学意义(U=19.37、23.99,均P=0.000;U=21.98、24.06,均P=0.000)。平均随访(46±39)个月,患肢膝下15cm处周径差降为,中央型(0.53±0.42)cm,混合型(1.42±1.35)cm,两者比较差异有统计学意义(U=13.38,P=0.000)。水肿、色素沉着、溃疡等后遗症发生率,中央型:27.91%(72/258)、13.18%(34/258)、0%;低于混合型:35.12%(171/487)、22.59%(110/487)、2.46%(12/487),差异有统计学意义(U=2.0,3.09,2.03;P=0.046,P=0.000,P=0.042)。中央型静脉通畅率(96.51%)和瓣膜功能正常率(78.68%),均高于混合型(78.03%和56.47%),差异均有统计学意义(U=6.62、6.01,均P=0.000)。中央型随访疗效为优92.64%,混合型65.09%(U=6.79,P=0.000)。结论中央型和混合型下肢深静脉血栓,机械性血栓碎吸的疗效显著,尤其中、长期疗效中央型明显好于混合型。
Objective To evaluate the medium-term and long-term clinical effect of acute lower extremity deep venous thrombosis(DVT),which included central and mixed type DVT,using the technique of manually mechanical aspiration thrombectomy.Methods The clinical data of 745 patients with acute and subacute lower extremity DVT from April 1998 to October 2011 were analyzed retrospectively.There were 389 males,356 females;the age ranged from 23 to 86 years old with mean age(58.72±11.95)years old.465 patients occurred on left leg,280 patients on right leg.There were 258 cases of central type(34.63%,258/745),487 cases of mixed type(65.37%,487/745).All the patients were implanted inferior vena cava filter,then inserted an 8-14 F catheter to the femoral vein of affected limbs to aspirate thrombus mechanically.Using big catheter to manually aspirate thrombus cooperated with different sizes of Fogarty balloon catheter and vessel dilate balloon catheter to pull the thrombus to iliac vein.Before aspirating thrombus,a balloon was put into the confluence of inferior vena cava and iliac vein,in case of thrombus fall off with blood flow to block inferior vena cave.213 cases who had common iliac vein stenosis or occlusion took methods of PTA and Stenting.A small dose urokinase and heparin were used to thrombolysis and anti-coagulation after mechanical aspiration thrombectomy of mixed type.Results The differences of circumference of healthy and affected limbs of knee-joint’s up and down 15 cm of central type at discharge were(1.34±1.07)cm and(0.93±0.52)cm,the mixed type at discharge were(2.89±1.53)and(1.72±0.89)cm,the difference has statistical significance(U=19.37 and 23.99;U=21.98 and 24.06;both P=0.000)compared with before operation.The incidence of complications that include edema,pigmentation,ulcer occured on central type(27.91%,13.18%,0%)were lower than mixed type(35.12%,22.59%,2.46%),the difference had statistical significance(U=2.0,3.09,2.03;P=0.046,P=0.000,P=0.042).The central type of venous patency rate(96.51%)and the normal rate of valve function(78.68%)were higher than the mixed type(78.03% and 56.47%).The difference of both had statistical significance(U=6.62,6.01,both P=0.000).The follow-up clinical effect that was excellent took up 92.64% in central type and 65.09% in mixed type(U=6.97,P=0.000).Conclusions The central and mixed type of lower extremity DVT,using mechanical aspiration thrombectomy,has a significant results,especially the medium-term and long-term clinical effect of central type was better than mixed type.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第24期8062-8068,共7页
Chinese Journal of Clinicians(Electronic Edition)
关键词
静脉血栓形成
手动机械性血栓抽吸
溶栓治疗
介入治疗
Deep venous thrombosis
Manual aspiration of thrombus
Thrombolysis therapy
Interventional therapy
