下肢深静脉血栓手术取栓与介入取栓疗效的比较研究

目的比较手术取栓与介入取栓对下肢深静脉血栓形成(deep vein thrombosis,DVT)的近、远期疗效。方法回顾分析2000年3月~2008年8月167例混合型和中心型DVT的临床资料,其中手术取栓87例,介入取栓80例,术后均局部应用尿激酶溶栓、肝素抗凝治疗,后期应用华法林抗凝6~12个月。结果治疗后介入组双大腿及小腿周径差中位数分别为0.8cm(-3.0~6.0cm)和0.7cm(0.0~5.5cm),手术组分别为1.6cm(0.0~8.0cm)和1.1cm(0.0~4.5cm)(Z=-3.932,P=0.000;Z=-3.313,P=0.001)。介入组住院时间(7.7±4.9)d,显著短于手术组(14.7±6.5)d(t=7.806,P=0.000)。介入组腹膜后血肿、肺部感染、伤口感染、淋巴漏等总的并发症发生率为8.8%(7/80),显著低于手术组35.6%(31/87)(χ2=17.135,P=0.000)。131例随访(47.3±28.3)月,2组大、小腿周径差,主观症状评分,色素沉着,静脉曲张,间歇跛行发生率等方面均无显著差异(P0.05)。结论手术取栓与介入取栓相比,远期疗效相当,但介入取栓对于混合型和中心型DVT的治疗时间窗宽,近期疗效更佳,且住院时间短,并发症少。

Comparison of Surgical Thrombectomy with Interventional Thrombectomy for Deep Vein Thrombosis of the Lower Extremity

Objective To compare the short-and long-term results of surgical and interventional thrombectomy for deep vein thrombosis of the lower extremity（DVT）.Methods Totally 167 cases of mixed or central type DVT,who were treated by surgical thrombectomy（87 cases）or interventional thrombectomy（80 cases）from March 2000 to August 2008 in our hospital,were reviewed.All the patients received urokinase and heparin for anticoagulation;and then warfarin for 6 to 12 months.Results After the operation,the differences between the circumference of the bilateral thigh and crus were 1.6 cm（0.0-8.0 cm）and 1.1 cm（0.0-4.5 cm）respectively in the surgical group,and 0.8 cm（-3.0-6.0 cm）and 0.7 cm（0.0-5.5 cm）in the intervention group（Z=-3.932,P=0.000;Z=-3.313,P=0.001）.The hospital stay in the interventional group was significantly shorter than that of the surgical group [（7.7±4.9）d vs（14.7±6.5）d;t=7.806,P=0.000].Moreover,the rate of complications（retroperitoneal hematoma,pulmonary infection,incisional infection,and lymph leakage）in the interventional group was significantly lower than that in the surgical group [8.8%（7/80）vs 35.6%（31/87）;χ2 =17.135,P=0.000].Follow-up was achieved in 131 patients for（47.3±28.3）months,during which no significant difference was observed between the two groups in the differences of bilateral thigh and crus circumference,symptoms score,occurrence rates of pigmentation,varicose veins and intermittent claudication（P0.05）.Conclusions Surgical thrombectomy is comparable to interventional thrombectomy in long-term outcomes,however,interventional thrombectomy shows wider therapeutic window,better short-term outcomes,shorter hospital stay and less complications than surgicall treatment.