经腘静脉置管溶栓治疗下肢深静脉血栓形成

目的初步探讨经腘静脉置管溶栓治疗下肢深静脉血栓(DVT)的临床应用价值。方法67例下肢深静脉血栓形成患者,在B超引导下行经腘静脉置入溶栓导管,以输液泵经溶栓导管持续泵入溶栓药物10~14d,同时行抗凝治疗。结果所有病人均置管成功,其中3例未能通过髂静脉;治疗后临床表现均有不同程度的好转,出院前均行影像学检查,治愈11例,其中8例病程≤10d,显效42例,有效16例,有效率100%;其中5例接受髂静脉球囊扩张术,3例行髂静脉支架置入术,1例行耻骨上静脉转流术。结论经腘静脉置管溶栓术治疗下肢深静脉血栓可以延长尿激酶溶栓时间窗,减少尿激酶用量,减少出血并发症,并为后续治疗提供机会。

Catheter directed thrombolysis for deep venous thrombosis of lower limbs

Objective:To discuss the feasibility of catheter directed thrombolysis deep venous thrombosis of lower limbs.Methods:67 cases of deep venous thrombosis of lower limbs from 12/2002 to 2/2005 were treated with catheter directed thrombolysis,the popliteal puncture under ultrasound guidance for the venous access, course of therapy continued for 10~14 day with anticoagulation.Results:The procedures of the popliteal puncture and catheter and guidewire exchanges were successful in all 67 cases,and were not permitted passing through iliac veins in 3 cases.Clinical manifestations were alleviated in all 67 cases.Implied by imaging examination before discharged from hospital,11 cases were completely cured,8 cases with the couse of diseases no more than 10 days,significantly improved in 42 cases,and improved in 16 cases.There were 5 cases accepted balloon dilatation in iliac venous,3 cases accepted iliac venous stent,1 case accepted by-pass surgery.Conclusion:The catheter directed thrombolysis deep venous thrombosis of lower limbs can prolong the time of thrombolysis,decrease the dosage of urokinase and complication of hemorrhage,and it can take the chance of subsequent therapy.