Targeted Thrombolytic Therapy

Venous and arterial thrombosis are closely related to many severe diseases, especially to cardiovascular and cerebrovasular disorders. Thrombolytic therapy has been proven to be an effective method to treat such disease, which decreased the mortality and morbidity greatly.     

单纯抗凝与导管内溶栓加抗凝治疗肺动脉栓塞疗效对比分析

目的评价单纯抗凝与导管内溶栓加抗凝治疗肺动脉栓塞疗效对比。方法经肺动脉造影或增强螺旋CT证实的急性肺动脉栓塞患者63例，随机分两组，一组单纯肝素抗凝32例，另一组导管内尿激酶溶栓加肝素抗凝31例。结果单纯抗凝治疗总有效率96．7％；导管内溶栓加抗凝治疗总有效率100％，但临床症状改善较快。单纯抗凝无效1例，经导管内溶栓后好转。经导管内溶栓出现消化道出血1例。本观察无1例死亡。结论单纯抗凝与导管内溶栓加抗凝治疗总有效率相近，无并发症出现。所以对无血液动力学改变的急性肺动脉栓塞单纯肝素抗凝即可取得确切疗效，可降低风险。     

两种顺行置管方式溶栓治疗急性髂股静脉血栓的对照研究

目的探讨经大隐静脉穿刺入路置管溶栓治疗急性髂股静脉血栓的应用价值。方法46例经造影明确诊断的急性髂股静脉血栓患者,随机分为2组,经患肢大隐静脉入路置管溶栓的为A组(21例),经患肢腘静脉入路置管溶栓的为B组(25例)。对两组患者总体治疗效果、静脉通畅度、患肢消肿率、穿刺置管消耗时间及治疗期间并发症发生率等进行观察比较。结果总体有效率A组95.2%;B组96.0%;消肿率A组(86.6±20.0)%,B组(85.7±14.6)%;静脉通畅度A组(57.9±19.4)%,B组(57.7±19.3)%。两组之间疗效差异无统计学意义(P>0.05)。A组穿刺消耗时间少于B组(P<0.05),大隐静脉穿刺难度低于腘静脉。大隐静脉置管的并发症发生率低于腘静脉置管(P<0.05)。结论经大隐静脉穿刺置管溶栓治疗急性髂股静脉血栓形成是简单易行、有效的方法。     

Endovascular Treatment for Lower Extremity Deep Vein Thrombosis: An Overview

Lower extremity deep vein thrombosis (DVT) is a serious medical condition that can result in local pain and gait disturbance. DVT progression can also lead to death or major disability as a result of pulmonary embolism, postthrombotic syndrome, or limb amputation. However, early thrombus removal can rapidly relieve symptoms and prevent disease progression. Various endovascular procedures have been developed in the recent years to treat DVT, and endovascular treatment has been established as one of the major therapeutic methods to treat lower extremity DVT. However, the treatment of lower extremity DVT varies according to the disease duration, location of affected vessels, and the presence of symptoms. This article reviews and discusses effective endovascular treatment methods for lower extremity DVT.     

Catheter-directed thrombolysis in inflammatory bowel diseases: Report of a case

In patients with inflammatory bowel diseases (IBD) the prevalence of thrombosis is 6.2%, the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population. The TE is a common extraintestinal complication of IBD, squarely associated with the IBD activity. The application of anticoagulant and thrombolytic therapy in severe IBD is an unresolved issue. Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT). A 46-year-old male patient is reported who had Crohn’s disease for 10 years. His right hand suddenly became cold and painful. Angiography proved acute occlusion of the brachial and radial artery. Vascular surgery intervention was not applicable. Endoscopy showed extended, severe inflammation of the colon. Despite the severe endoscopic findings, frequent bloody stools and moderate anaemia, CDT with recombinant tissue plasminogen activator was performed. The control angiography proved improvement, the radial artery pulse appeared. No bleeding complication was observed. This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.     

导管溶栓术治疗急性下肢深静脉血栓形成的疗效观察

目的：探讨导管溶栓术治疗急性下肢深静脉血栓形成的临床效果及安全性.方法：选择82例下肢深静脉血栓形成患者,全部患者均在抗凝的同时配合导管溶栓治疗,观察患者的临床疗效及不良反应情况.结果：全组患者溶栓后症状明显改善,下肢肿胀消退,肺部症状缓解.溶栓前大腿周径差（5.83±0.52）cm,溶栓前小腿周径差（4.90±1.27）cm;溶栓后大腿周径差（2.66±0.82）cm,溶栓后小腿周径差（1.90±0.53）cm.所有患者均无严重并发症.82例患者获随访,随访6～12个月,平均（8.1±1.3）个月.无一例出现血栓再发.结论：导管溶栓术治疗下肢深静脉血栓形成,临床操作简单,治疗效果明显,并发症少,能显著改善患者的生活质量,值得临床推广.     

经皮机械性血栓清除联合导管溶栓与单纯导管溶栓治疗急性下肢缺血的疗效比较

目的比较PMT联合CDT与单纯CDT治疗急性下肢缺血的临床疗效。方法回顾性分析2017年1月至2018年12月苏州大学附属第一医院收治的64例急性下肢缺血患者的临床资料,其中24例行PMT联合CDT治疗(PMT组),40例行单纯CDT治疗(CDT组)。比较两组手术成功率、尿激酶用量、手术时间、溶栓时间、住院时间、住院期间并发症发生率和术后30 d内截肢率、再次手术率及死亡率。结果两组手术均取得成功,技术成功率为100%;PMT组和CDT组的尿激酶用量分别为(56.67±8.16)万U和(106.50±47.56)万U,手术时间分别为(103.33±25.57)min和(72.13±25.74)min,溶栓时间分别为(24.96±12.52)h和(61.20±29.24)h,住院时间分别为(7.13±2.52)d和(9.35±2.65)d,差异均有统计学意义(P<0.01)。两组住院期间并发症发生率(16.7%vs 17.5%)、术后30 d内截肢率(12.5%vs15.0%)、再次手术率(4.2%vs 7.5%)及死亡率(8.3%vs 2.5%)差异均无统计学意义(P>0.05)。不同缺血时间患者的缺血改善情况,两组比较差异均无统计学意义(P>0.05)。结论采取PMT联合CDT治疗急性下肢缺血患者在手术疗效、并发症发生情况结果和单纯CDT相似,但可降低溶栓药物用量、缩短溶栓时间和住院时间。     

下肢深静脉血栓形成导管溶栓术后髂静脉病变支架治疗的前瞻性对照性研究

目的观察下肢深静脉血栓形成(DVT)导管接触性溶栓(CDT)术后髂静脉支架治疗髂静脉病变的疗效。方法本研究为单中心前瞻性随机对照研究。155例下肢DVT患者经CDT治疗后,髂静脉远端主干静脉完全通畅,髂静脉残留狭窄大于50%者中的74例患者随机分为对照组和实验组:实验组45例行髂静脉支架置入,对照组29例髂静脉未置入支架。观察指标:深静脉通畅率,CEAP分类法中临床分级(C)变化,静脉临床严重程度计分(VCSS)变化及生活质量调查表(CIVIQ)评分。结果术后患者均获得随访,随访时间6～24个月。行静脉造影或彩超检查,实验组40例,对照组27例,实验组与对照组的终点通畅率比较差异有统计学意义[87.5%(35/40)vs29.6%(8/27),P<0.05];实验组与对照组的1年累积通畅率比较差异有显著统计学意义(86.0%vs54.8%,P<0.01)。实验组及对照组的CEAP分类法中临床分级(C)术前术后差值比较差异有统计学意义(1.61±0.21vs0.69±0.23,P<0.01)。随访终点实验组及对照组VCSS术后两组差值比较差异有统计学意义(7.57±0.27vs6.56±0.23,P<0.01)。实验组及对照组CIVIQ调查表终点评分比较差异均有统计学意义(22.67±3.01vs39.34±6.66,P<0.01)。结论髂静脉支架对下肢DVT导管溶栓术后治疗髂静脉病变能够提高深静脉的通畅率,提高疗效,提高生活质量。     

深静脉血栓的血管内溶栓治疗

通过对深静脉血栓的血管内溶栓治疗分析，提供一种有效的治疗静脉血栓的新方法。本组７例，左髂总静脉血栓４例，左髂外静脉２例，右髂外静脉１例，７例均先插管逆，顺行静脉造影确定血栓长度及病变程度。     

超声引导置管溶栓治疗下肢深静脉血栓

目的探讨超声引导置管溶栓治疗下肢深静脉血栓(DVT)的临床应用价值。方法收集55例下肢DVT患者,分为置管溶栓组(n=35)和对照组(n=20)。治疗前对所有患者均行超声检查以了解DVT情况。置管溶栓组:下腔静脉滤器置入术后,在超声引导下行患肢静脉置管,用微量泵持续向导管内给予尿激酶和肝素;对照组经静脉注射溶栓尿激酶和肝素进行全身治疗。治疗后所有患者均复查超声,观察疗效并进行比较。结果置管溶栓组所有患者置管成功,其中26例治愈,6例有效,3例无效,总有效率为91.43%(32/35)。对照组5例治愈,8例有效,7例无效,总有效率为65.00%(13/20)。两组疗效差异有统计学意义(χ2=12.99,P0.05)。结论超声引导置管溶栓治疗下肢DVT特异性高、见效快、疗程短,是治疗下肢DVT的有效方法。