经皮机械血栓清除联合球囊血管成形治疗髂股静脉血栓形成患者疗效分析

目的: 评价经皮机械血栓清除（PMT）联合球囊血管成形（PTA）治疗髂股静脉血栓形成患者的临床疗效。方法: 回顾性分析2015年11月至2017年12月于宁波市第二医院血管外科住院治疗的94例髂股静脉血栓形成患者的临床资料，根据吸栓前是否联合PTA分为PMT+PTA组（50例）和单纯PMT组（44例），比较两组的疗效，下腔静脉滤器取出及栓塞情况，治疗前后血清肌酐、乳酸脱氢酶、血红蛋白的变化，以及症状性肺栓塞、腘窝穿刺点出血等并发症的发生情况。结果: 所有患者均顺利完成手术。PMT+PTA组平均血栓清除率较单纯PMT组高，吸栓时间较PMT组短（均P < 0.01），但两组间髂股静脉狭窄率、支架植入率及辅助导管直接溶栓率差异均无统计学意义（均P>0.05）。两组下腔静脉滤器取出率分别为82.0%（41/50）和81.8%（36/44），差异无统计学意义（P>0.05）。两组术后血清肌酐、乳酸脱氢酶、血红蛋白变化差异均无统计学意义（均P>0.05）。PMT+PTA组术后发生症状性肺栓塞1例（2.0%），腘窝穿刺点出血2例（4.0%）；单纯PMT组未发现症状性肺栓塞者，腘窝穿刺点出血的发生率为4.5%（2/44），与PMT+PTA组差异无统计学意义（P>0.05）。结论: PMT联合PTA治疗髂股静脉血栓形成不仅缩短了吸栓时间、血栓清除效果更好，同时不增加肺栓塞发生率，值得临床推广应用。

Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis

Objective: To evaluate the clinical efficacy of percutaneous mechanical thrombectomy (PMT) combined with percutaneous transluminal angioplasty (PTA) in the treatment of iliofemoral deep vein thrombosis. Methods: Ninety-four patients with iliofemoral deep vein thrombosis were identified in this retrospective study in our institution from November 2015 through December 2017. Patients were divided into two groups:PMT+PTA group (n=50) and PMT only group (n=44). Clot lysis rates, the retrieving and the embolism of the interior vena cava filter, as well as the incidence of complications were compared between two groups. The changes of serum creatinine, lactate dehydrogenase and hemoglobin were also measured perioperatively. Results: All procedures were completed successfully. The average clot lysis rate was higher and the procedure time was shorter in PMT+PTA group than those in PMT group (both P < 0.01). No significant differences were found in the rates of venous stenosis, catheter-directed thrombolysis and stent placement between two groups (all P>0.05). The interior vena cava filter was taken out in 82.0% (41/50) patients of PMT+PTA group and 81.8% (36/44) patients of PMT group (P>0.05). There were no significant differences of the changes in serum creatinine, lactate dehydrogenase and hemoglobin (all P>0.05). In PMT+PTA group, symptomatic pulmonary embolism and puncture bleeding occurred in 1(2.0%) and 2(4.0%) patients, while in PMT group, it was 0 and 2(4.5%), respectively (P>0.05). Conclusion: PMT combined with PTA is more effective than PMT alone for the treatment of iliofemoral deep vein thrombosis with less procedure time and without more incidence of pulmonary embolism.