急性髂股型下肢深静脉血栓形成Fogarty导管取栓与药物溶栓的疗效比较

目的探讨急性髂股型下肢深静脉血栓形成Fogarty导管取栓与药物溶栓的临床疗效。方法回顾性分析2000年03月-2008年01月间治疗的175例髂股型下肢深静脉血栓形成的临床资料。本组应用Fogarty导管取栓85例,其中合并髂总静脉严重狭窄或闭塞的23例,术后给予尿激酶、低分子肝素溶栓抗凝治疗。采取药物溶栓治疗90例,给予尿激酶、低分子肝素治疗。结果治疗前两组患肢病程及肿胀差异无统计学意义（P〉0．05）。治疗后1月,双下肢的周径差,手术组由（4．3±1．6）cm下降为（0．8±0．5）cm,溶栓组由（4．0±1．9）cm下降为（1．8±1．3）cm。手术组治愈率71．8％,溶栓组治愈率38．9％,（χ2=5．362,P=0．021）。平均随访（28．5±11．3）个月．随访率70．9％。双下肢周径手术组下降为（0．5±0．2）cm,溶栓组下降为（1．2±0．5）cm。手术组治愈率75．8％,溶栓组治愈率45．9％,（χ2=11．556,P=0．001）。手术组的下肢深静脉血栓形成后遗症发生率低于溶栓组（P〈0．05）,手术组的静脉瓣功能异常的发生率低于溶栓组（P〈0．05）。结论急性髂股型下肢深静脉血栓形成Fogaay导管取栓疗效优于药物溶栓。     

经导管取栓及溶栓治疗急性下肢深静脉血栓

目的探讨经导管取栓及溶栓技术治疗急性下肢深静脉血栓的临床价值及疗效。方法收集急性下肢深静脉血栓患者117例,其中中央型血栓71例,混合型血栓46例。在下腔静脉滤器保护下,对患者行经大腔导管取栓及溶栓导管溶栓治疗,对合并Cockett综合征者行支架成形治疗。结果手术成功率100%,患肢肿胀、疼痛于术后当日即明显减轻,无肺栓塞发生。110例患者均成功随访12个月,总有效率97.27%(103/110)。结论经导管取栓及溶栓治疗急性下肢深静脉血栓安全、有效。     

Fogarty导管取栓术治疗急性下肢深静脉血栓形成的体会

1982年5月～1995年4月间,本科对103例(110侧)急性下肢深静脉血栓形成患者的诊治进行总结:56例(50.9％)采用急诊Fogarty导管取栓术,54例(49.1％)采用尿激酶及肝素溶栓抗凝法。发现近期效果二者之间相差不明显。 73例随访1～10年,平均6.4年。其中40例为手术取栓,33例为溶栓后。手术病人中8例(20.2％)症状消失,13例(32.5％)出现浅静脉及皮肤色素沉着,4例(10.0％)发生小腿溃疡;溶栓病人6例(18.2％)症状消失,15例(45.5％)出现浅静脉及皮肤色素沉着,8例(24.2％)发生小腿溃疡。 手术取栓保护了部分主干静脉辦膜,对减少深静脉血栓形成的远期并发症有益。     

急性混合型下肢深静脉血栓大腔导管取栓与单纯溶栓的疗效比较

目的:比较大腔导管取栓与单纯溶栓对急性混合型下肢深静脉血栓形成(LEDVT)的疗效。方法:回顾性分析11年间收治的458例急性混合型LEDVT患者的临床与随访资料。其中327例(A组)接受大腔导管血栓抽吸术,另131例(B组)接受尿激酶系统溶栓治疗。结果:A组术中无严重并发症发生,B组治疗中2例因出血而危及生命。平均住院时间A组6.5 d,B组9.5 d(P<0.05);治愈率A组94.8%,B组37.4%(P<0.05)。术后36~48个月,双下肢膝下15 cm处周径差A组为(0.53±0.42)cm,B组为(1.42±1.35)cm(P<0.05);水肿、色素沉着、溃疡等发生率,A组分别为27.83%,13.15%和0,B组分别为55.73%,83.97%和9.16%(均P<0.05);A组静脉通畅率为90.83%,瓣膜功能正常率为73.09%,均明显高于B组(37.41%和15.27%)(均P<0.05);A组和B组总有效率分别为100%和71.76%(P<0.05)。结论:大腔导管取栓对急性混合型下肢深静脉血栓形成的疗效优于单纯溶栓,尤其在保护静脉瓣膜功能方面更为明显。     

吸栓后导管溶栓与单纯导管溶栓对急性混合型下肢深静脉血栓的疗效比较

目的:比较吸栓联合导管溶栓与单纯导管溶栓对急性混合型下肢深静脉血栓(LEDVT)的疗效。方法:回顾性分析2012年6月—2017年6月收治的121例急性混合型LEDVT患者资料,其中60例先吸栓再导管溶栓治疗(吸栓后溶栓组),61例直接行导管溶栓治疗(单纯溶栓组),比较两组患者的相关临床指标。结果:两组治疗前一般资料无统计学差异(均P0.05)。与单纯溶栓组比较,吸栓后溶栓组平均住院天数明显缩短(6.2 d vs. 10.5 d,P0.05),尿激酶平均用量明显减少(170万U vs. 290万U,P0.05);吸栓后溶栓组与单纯溶栓组术后1周的治愈率和有效率分别为75%、45.9%与91.67%、88.52%,术后2周分别为83.33%、62.3%与96.72%,91.81%,吸栓后溶栓组治愈率明显高于单纯溶栓组(均P0.05),有效率两组间差异无统计学意义(均P0.05)。术后随访12个月,两组并发症发生率、膝下15 cm处健患肢周径差降低程度、静脉通畅率、静脉瓣膜功能正常率以及总有效率差异无统计学意义(均P0.05)。结论:与单纯导管溶栓相比较,吸栓后溶栓能明显缩短急性混合型LEDVT患者住院时间,减少尿激酶用量,提高治愈率,但中长期疗效差异不大。     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

目的 比较手术取栓与介入取栓治疗急性下肢深静脉血栓形成(DVT)的近、远期疗效.方法 回顾性分析2000年3月至2008年8月136例急性混合型和中心型DVT患者的临床资料.手术取栓组80例,其中男性30例,女性50例;年龄26-81岁,平均(58±14)岁.介入取栓组56例,其中男性25例,女性31例;年龄22～92岁,平均(57±17)岁.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 介入取栓组治疗后双大腿周径差小于手术取栓组[(0.8±1.3)cm比(1.5±1.7)cm,P=0.002],两组小腿周径差异无统计学意义[(0.7±1.1)cm比(1.0±1.1)cm,P=0.152].介入取栓组的平均住院时间少于手术取栓组[(7±4)d比(15 4-7)d,P=0.000].介入取栓组并发症发生率低于手术取栓组(8.9%比32.5%,P=0.000).108例获随访,随访率为79.4%.平均随访(46±29)个月,两组在大、小腿周径差、症状评分、色素沉着、静脉曲张、间歇性跛行及慢性溃疡的发生率等方面差异均无统计学意义(P>0.05).结论 介入取栓与手术取栓相比,远期疗效相当,近期疗效更佳,且住院时间短,并发症少.     

经腘静脉插管定向溶栓治疗下肢深静脉血栓形成的临床研究

目的评价腘静脉插管定向溶栓治疗下肢深静脉血栓的疗效。方法 62例下肢深静脉血栓患者,行患肢腘静脉穿刺插管,在可视条件下将导管插入至血栓近心端,经导管首次推注尿激酶20万单位后,持续注射尿激酶10万单位／h溶栓,同时每12 h皮下注射低分子肝素钠400 U。以下肢肿胀消退情况评价疗效,以深静脉造影评价溶栓效果。结果经导管溶栓治疗不仅使深静脉血栓部分或完全消融,而且侧支循环开放较治疗前显著增加。患肢总消肿率(78±22)％,总溶栓率(67± 27)％,其中急性、急慢性和慢性病例溶栓率分别为75％、71％,49％,前两者显著高于后者(P< 0．05)。21例患者血栓完全消融,无严重并发症发生。结论 腘静脉插管定向溶栓治疗下肢深静脉血栓形成能够快速溶解血栓,恢复深静脉血流通畅,患者临床症状改善效果满意,治疗方案安全可靠。     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

急性下肢深静脉血栓手术取栓与介入取栓的疗效分析

Objective To study the short- and long-term results for acute deep vein thrombosis (DVT) of the lower extremity treated by surgical thrombectomy and interventional thrombectomy. Methods One hundred and thirty-six acute DVT cases treated by surgical thrombectomy or interventional thrombectomy from March 2000 to August 2008 were reviewed. There were 80 patients treated by surgical thrombectomy. Among them, 30 cases were male, 50 cases were female, aged from 26 to 81 years with a mean of (58 ± 14 ) years. The other 56 cases were treated by interventional thrombectomy. Among them, 25 cases were male, 31 cases were female, aged from 22 to 92 years with a mean of (57 ±17) years. All the 136 patients received district anticoagulation with heparin and thrombolysis with urokinase after operation. Results After operation, the circumference difference between bilateral thigh in intervention group were less than that in surgical group [ (0. 8 ±1. 3) cm vs. ( 1. 5 ± 1. 7) cm, P =0.002]. The circumference difference of bilateral calf had no significant difference [(0. 7 ± 1. 1 ) cm vs. ( 1. 0 ±1. 1) cm, P = 0. 152]. The average hospital stay in intervention group was shorter than that in surgical group [(7±4) dm. (15±7) d, P =0. 000 ]. The morbidity of complications in intervention group was less than that in surgical group (8. 9% vs. 32. 5% , P -0. 000). One hundred and eight patients were followed up, who was 79.4% of the total patients, and were followed up for an average of (46 ± 29) months. The circumference difference of thigh and calf, the symptom grade, the pigmentation, varicose veins, intermittent claudication and ulceration between the two groups had no significant difference(P > 0. 05). Conclusion Compared with surgical group, intervention group has a better short-term effect, shorter hospital stays, less complications and similar long-term result.     

抗凝溶栓治疗对急性下肢深静脉血栓形成预后的影响

目的 探讨抗凝溶栓治疗对急性下肢深静脉血栓形成的疗效及其对下肢深静脉血栓形成后综合征(PTS)的发生率及严重程度的影响.方法 回顾性选择2003年3月至2008年12月收治的急性下肢深静脉血栓形成(中央型及混合型)患者共111例(113条肢体).分别采用单纯抗凝(41条肢体)、系统溶栓(27条肢体)或导管溶栓(45条肢体)三种不同治疗方法,在随访期末收集下肢肿胀及静脉冉通情况,使用Villaha及VCSS评分表评判PTS的发生率及严重程度.结果 单纯抗凝组、系统溶栓组和导管溶栓组平均随访时间分别为(41±19)、(52±11)和(26±10)个月.三组PTS的发生率分别为58.5%(24/41)、55.6%(15/27)和35.6%(16/45),其中重度PTS的比例分别为20.8%(5/24)、3/15和1/16;导管溶栓组的PTS发生率和重度PTS比例低于其余两组(P＜0.05).三组患者双下肢周径差较治疗前均有明显改善(P＜0.05);导管溶栓组随访时的大腿周径差为(0.5 4±1.0)cm,小腿周径差为(0.7±1.0)cm,低于其余二组(P＜0.05).长期使用抗凝药物及弹力袜的患者,PTS发生率较低.结论 深静脉血栓形成急性期在抗凝基础上采用导管溶栓治疗,可降低PTS的发生率并减轻其严重程度,明显改善肢体肿胀.辅以规律抗凝及弹力袜支持,可进一步改善疗效.

Abstract：

Objective To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS). Method A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies:anticoagulant group (41 limbs) , thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS. Results The average time of follow-up were (41±19) months in anticoagulant group, (52±1) months in thrombolysis group, and (26 ±10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58. 5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS ( P ＜ 0. 05 ). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0. 5 ±1. 0) cm and (0. 7±1. 0) cm, which were more obvious compared to other two groups (P ＜0. 05).Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant Pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS. Conclusions The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheterdirected thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.     

无滤器保护导管溶栓治疗早期左下肢深静脉血栓

目的 探讨无滤器保护导管溶栓治疗早期左下肢深静脉血栓的适应证、安全性和疗效.方法 2008年7月至2010年6月采用无滤器保护B超引导置管溶栓治疗早期左下肢深静脉血栓54例.男性25例,女性29例,平均年龄52.8岁.中央型3例,混合型51例.病程≤7 d者45例,8 ～30 d者9例.B超检测为完全性,无漂浮血栓,下腔静脉无血栓.经导管泵入尿激酶30万U/2 h,2次/d;皮下注射低分子肝素4000 U,2次/d;或持续泵入普通肝素18 U· kg-1 ·h-1.结果 技术成功率100％.溶栓疗程6～10d,溶栓前评分10.8±1.0,溶栓后评分4.6±2.1;溶栓率(58±18)％,病程≤7 d与8 ～30 d患者相比差异无统计学意义(t=1.02,P=0.34).治疗14 d后痊愈20.4％(11/54),显著好转64.8％ (35/54),好转14.8％ (8/54),总有效率100％.无症状性肺栓塞发生,溶栓前血氧饱和度(91.0±2.6)％,溶栓期间为(90.8±2.4)％,差异无统计学意义(t=2.03,P=0.05).无血尿及脑出血等并发症,导管感染率7.4％( 4/54),穿刺部位有少量出血20.4％(11/54).随访6 ～21个月,随访率66.7％ (36/54);31例患者下肢肿胀完全消失或活动后轻度肿胀,2例患者活动后肿胀较明显,多普勒超声提示股静脉瓣膜功能不全,3例复发.结论 对于完全性、无漂浮血栓、下腔静脉无血栓的早期左下肢深静脉血栓,无滤器保护导管溶栓安全有效.     

接触性溶栓治疗犬急性中央型下肢深静脉血栓

目的探讨尿激酶给药方式和溶栓导管位置对急性中央型下肢深静脉血栓溶栓效果的影响。方法将30只实验犬的30条静脉随机分为五个实验组,每组6条,每组尿激酶给药方式和溶栓导管位置不完全相同。通过造影观察溶栓效果,记录每组再通时间、尿激酶用量、并发症情况、APTT值等。结果在尿激酶给药方式不同的前提下比较,A、B、C三组中,B组再通时间最短,C组再通时间居中,A组再通时间最长(P0.01)。在导管位置不同的前提下比较,B组再通时间明显短于D组。结论大剂量尿激酶冲击后,续以小剂量尿激酶持续溶栓,并将溶栓导管首端置于血栓远心端,治疗的方案效果更好、更安全。     

急性混合型下肢深静脉血栓取栓与溶栓远期疗效分析

目的 比较手术取栓与系统溶栓对急性混合型下肢深静脉血栓形成(DVT)的远期疗效.方法 回顾分析1991年9月至2005年6月的142例急性混合型DVT病例的临床资料.手术取栓77例,其中合并髂总静脉狭窄或闭塞49例,对于髂总静脉严重狭窄或闭塞者采取不同方法处理.手术后辅以区域性尿激酶溶栓、肝素抗凝治疗.系统溶栓65例,均系统性应用尿激酶、肝素.结果 治疗后2周,手术取栓组双下肢周径差由(4.3±2.2)cm降为(0.6±0.5)cm,系统溶栓组由(3.9±2.5)cm降为(1.6±0.9)cm,差异有统计学意义(t=-8.346,P=0.00).平均随访(49±42)个月,手术取栓组周径差降为(0.5±0.4)cm,系统溶栓组降为(1.4±1.3)cm(t=-5.764,P=0.00);手术取栓组水肿、色素沉着、溃疡等后遗症发生率分别为29.9%、15.6%、0%,低于系统溶栓组的50.8%、84.6%、6.2%(P＜0.05).彩超发现,手术取栓组静脉通畅率(89.6%)和瓣膜功能正常率(72.7%),均高于系统溶栓组(分别为30.8%、9.2%)(Z=-8.502,P=0.00).手术取栓组治愈率70.1%,高于系统溶栓组治愈率30.8%(Z=-4.740,P=0.00).手术组死亡率为3.9%,溶栓组无住院死亡率.结论 本组资料显示手术取栓对急性混合型DVT的疗效好于系统溶栓,尤其在保护静脉瓣膜功能方面明显优于系统溶栓;但手术创伤较大、有一定的死亡率.     

评价不同灌注模式溶栓治疗急性髂股静脉血栓的疗效

目的评价采用不同灌注模式导管接触性溶栓（CDT）治疗急性髂股静脉血栓的疗效。方法对65例急性髂股静脉血栓患者进行CDT治疗,术前随机分为3组：A组：21例,采用脉冲注射;B组：22例,采用连续泵入;C组：22例,采用先脉冲注射再连续泵入。24 h内以相同剂量尿激酶连续溶栓72 h,期间采用血管造影监测血栓溶解情况,观察不同溶栓灌注模式对溶栓疗效及并发症发生率的影响。结果 A、B、C组总有效率分别为71.43%、63.64%和77.27%;肢体消肿率分别为（80.00±22.10）%、（67.50±16.40）%和（92.30±15.80）%;静脉通畅度分别为（57.80±18.70）%、（55.60±19.30）%和（70.20±19.80）%。C组溶栓总有效率、肢体消肿率和静脉通畅度均明显高于A、B两组（P均〈0.01）,3组并发症的发生率差异无统计学意义（P〉0.05）。结论采用先脉冲注射再连续泵入的溶栓灌注模式进行CDT可作为治疗急性髂股静脉血栓患者的首选灌注方式。     

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。