经动脉置管持续性溶栓治疗下肢深静脉血栓形成

目的:评价动脉置管持续溶栓治疗急性下肢深静脉血栓形成（LEDVT）的效果。方法:68例急性LEDVT患者随机分为两组：经动脉置管溶栓组（A组，n=37）和经静脉溶栓组（B组，n=31）。监测治疗前后PT，FIB，D-两聚体及健、患肢周径，以治疗前、后周径差的减小判断肢体肿胀的缓解程度；通过静脉造影或彩超，以静脉通畅度评分和静脉通畅改善度指标评价疗效。结果:A组治疗过程中无出血发生，B组4例出现不同程度的出血。两组治疗后均出现PT延长、FIB降低、D-两聚体减少，与治疗前比较，差异均有显著（P<0.05）,但两组间差异无显著性（P>0.05）。两组溶栓后肢体肿胀缓解程度A组大于B组（P<0.01）。A组通畅改善度为（54.81±3.21）％，B组通畅改善度为（31.52±3.89）％，两者差异有显著性（P<0.01）。结论:经动脉置管溶栓治疗急性LEDVT是一种安全有效的方法。     

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。     

超声引导下置管溶栓治疗下肢深静脉血栓形成

下肢深静脉血栓形成(deep venous thrombosis,DVT)已成为临床多发病之一。DVT后期可发生深静脉功能不全等一系列病变,严重影响病人的生活质量。目前常用的治疗方法倾向于非手术疗法,主要包括溶栓、抗凝、祛聚等药物治疗。静脉取栓术因其创伤大、术后易复发效果欠佳。我院自2002年12月开始采用超声引导下置管溶栓术治疗下肢深静脉血栓形成。取得     

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。     

可回收腔静脉滤器置管溶栓治疗下肢深静脉血栓

目的:探讨可回收腔静脉滤器在置管溶栓治疗下肢深静脉血栓中的作用.方法:对接受可回收腔静脉滤器植入术的患者进行随访,根据是否进行置管溶栓治疗分为置管溶栓组28例和对照组63例,观察溶栓效果及两组滤器捕获率及滤器回收率有无差异.结果:置管溶栓组24例血栓溶解率超过50%;血栓捕获率及滤器回收率明显高对照组(均P<0.05).结论:置管溶栓过程中存在着较高的血栓脱落率,使用可回收腔静脉滤器是安全、有效的.     

滤器保护下置管溶栓治疗下肢深静脉血栓形成临床总结

目的探讨滤器保护下经胭静脉置管溶栓治疗下肢深静脉血栓形成的临床应用价值。方法对2002年12月至2005年2月收治的51例下肢深静脉血栓形成病人，在滤器保护下经B超引导，由胭静脉置入溶栓导管，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。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，显效34例，有效6例。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。结论下腔静脉滤器保护下行膪静脉置管溶栓，可防止肺栓塞，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。     

下肢深静脉血栓形成置管溶栓治疗时机选择的临床分析

目的 探讨下腔静脉滤器置入后置管溶栓治疗下肢深静脉血栓形成(DVT)的疗效及时机的选择.方法 回顾性分析我科收治的经下肢顺行深静脉造影证实的136例中央型和混合型下肢DVT患者的临床资料,根据置管溶栓前病程的长短,将其分为三组.A组46例,病程≤3d;B组44例,3d<病程≤7d;C组46例,7d<病程≤14d.患者治疗方法均采用下腔静脉滤器置入后置管溶栓,同时行常规消肿、活血化瘀等,比较三组患者7d疗程后治疗的效果.结果 治疗7d后无一例发生严重并发症,总有效率A组为95.65%,B组为90.91%,C组为69.57%,A、B两组比较差异无统计学意义(P>0.05),A、C两组和B、C两组分别比较差异有统计学意义(P<0.05).结论 DVT置管溶栓治疗时机的选择上,病程≤3d与3d<病程≤7d,还不能认为有差别,而病程≤3d、3d<病程≤7d均明显优于7d<病程≤14d.     

置管溶栓与系统溶栓对下肢深静脉血栓形成的疗效比较

目的 :比较置管溶栓与系统溶栓对下肢深静脉血栓形成的临床疗效。方法 :选择2013年2月—2015年7月在我院接受治疗的单侧下肢深静脉血栓形成患者102例,以数字表法随机分为观察组及对照组各51例。其中对照组患者行系统溶栓治疗,观察组患者行置管溶栓治疗。对所有患者进行随访,对比两组临床效果。结果:观察组大腿消肿率、小腿消肿率、静脉通畅率、溶栓率均显著高于对照组;观察组溶栓时间为(5.2±1.7)d,显著低于对照组的(6.8±2.1)d,差异有统计学意义(t=4.229,P=0.000);观察组血管通畅例数占比显著高于对照组,而残留大量血栓例数占比明显低于对照组,差异均有统计学意义(均P<0.05)。结论:置管溶栓治疗下肢深静脉血栓形成效果显著,能缩短血流恢复时间,且深静脉通畅率远优于系统溶栓治疗。     

导管溶栓治疗下肢深静脉血栓形成

目的:观察导管溶栓治疗急性下肢深静脉血栓形成的早中期疗效。方法:将26下肢深静脉血栓形成患者分为两组,治疗组9例在抗凝的同时配合导管溶栓治疗,对照组17例仅行抗凝治疗。结果:治疗后早期,两组健患肢周径差与治疗前相比均有明显缩短,两组间术后健患肢周径差亦有明显缩短。随访18～30个月,两组血栓溶解率有明显差异。结论:导管溶栓能改善急性下肢深静脉血栓的早中期疗效。     

深静脉血栓形成置管溶栓的临床分析

探讨系统溶栓与置管溶栓在深静脉血栓形成中的应用及临床效果。回顾分析91例深静脉血栓患者的临床资料,采取系统溶栓治疗(A组,50例)及置管溶栓治疗(B组,41例),并根据患者肢体治疗前后的周径变化、血管造影评估溶栓治疗效果。治疗前后两组患者肢体肿胀程度均获得了不同程度的改善,A组大、小腿消肿率分别为(51.41±34.43)%、(53.61±29.10)%;B组大、小腿消肿率分别为(71.74±32.17)%、(68.33±28.62)%,两组消肿率差异有统计学意义(P0.05);A、B组住院时间分别是(13.92±2.36)d、(12.05±3.91)d,差异有统计学意义(P0.05)。A组并发症发生率8.00%;B组并发症发生率7.31%,差异无统计学意义(P0.05)。两组尿激酶用量差异亦无统计学意义(P0.05)。系统溶栓和置管溶栓治疗深静脉血栓均有效,置管溶栓起效迅速,不增加并发症。     

急性下肢深静脉血栓形成局部置管溶栓与外周静脉溶栓的比较

Objective To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. Methods There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. Results Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94. 4% vs. 69. 5% ,P＜0. 01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85. 9% vs. 75. 3% , P ＞0. 05). A mean follow-up period was (43 ±18) months.There was no significant difference in incidence of complication and recurrence between two groups.Conclusions The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.     

急性下肢深静脉血栓形成局部置管溶栓与外周静脉溶栓的比较

Objective To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. Methods There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. Results Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94. 4% vs. 69. 5% ,P＜0. 01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85. 9% vs. 75. 3% , P ＞0. 05). A mean follow-up period was (43 ±18) months.There was no significant difference in incidence of complication and recurrence between two groups.Conclusions The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.     

急性下肢深静脉血栓形成局部置管溶栓与外周静脉溶栓的比较

目的 比较急性下肢深静脉血栓形成经局部及外周静脉抗凝溶栓治疗的效果,以指导临床治疗.方法 回顾性分析我院2001年1月至2008年5月期间收治的225例下肢深静脉血栓形成患者的临床资料,按照治疗方法分A、B两组.A组为经股深静脉置管抗凝溶栓治疗患者,共71例,左侧47例,右侧20例,双侧4例;B组为经外周静脉抗凝溶栓治疗的患者,共154例,左侧121例,右侧27例,双侧6例.通过监测患者临床症状、测量下肢周径变化比较两组治疗效果.结果 A组患者治疗3 d后好转率优于B组患者(94.4%比69.5%,P＜0.01).治疗7 d后,A组的治愈率虽然优于B组患者,但差异无统计学意义(85.9%比75.3%,P＞0.05).治疗后平均随访(43±18)个月,两组的并发症及复发率差异无统计学意义(P＞0.05).结论 股静脉置管局部溶栓治疗的早期疗效优于经外周静脉给药,但两种方法的中远期治疗效果相似.

Abstract：

Objective To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. Methods There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. Results Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94. 4% vs. 69. 5% ,P＜0. 01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85. 9% vs. 75. 3% , P ＞0. 05). A mean follow-up period was (43 ±18) months.There was no significant difference in incidence of complication and recurrence between two groups.Conclusions The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.     

急性下肢深静脉血栓形成局部置管溶栓与外周静脉溶栓的比较

Objective To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. Methods There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. Results Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94. 4% vs. 69. 5% ,P＜0. 01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85. 9% vs. 75. 3% , P ＞0. 05). A mean follow-up period was (43 ±18) months.There was no significant difference in incidence of complication and recurrence between two groups.Conclusions The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.     

下肢深静脉血栓形成的溶栓治疗进展

<正>静脉血栓栓塞症(venous thromboembolism,VTE)是深静脉血栓形成(deep venous thrombosis,DVT)与肺栓塞(pulmonary embolism,PE)的总称[1]。亚洲VTE的年发病率为(14～57)/100000[2]。DVT在普通人群中发病率约1/1000[3],其中1/3会发展成PE[4]。VTE若未得到正规、有效的治疗,将严重影响患者的生活质量,并造成严重的经济负担。研究指出20%～50%的DVT患者在1～2年内发展为深静脉血栓形成后综合征(post thrombotic syndrome,PTS)[5],导致患肢长期肿胀、皮肤退化、色素沉着、     

急性下肢深静脉血栓形成的溶栓治疗

目的:探讨急性下肢深静脉血栓形成的溶栓治疗疗效.方法:总结病人共126例,均以溶栓治疗为主.结果:临床治愈85例,良好34例,进步5例,无效2例,总有效率94.9%.结论:绝大多数下肢深静脉血栓形成的病人可以经溶栓和抗凝为主的非手术治疗达到满意的临床疗效.     

从5年随访结果评价置管溶栓治疗下肢深静脉血栓形成的疗效

目的 比较置管溶栓和系统溶栓治疗下肢深静脉血栓形成(DVT)患者远期发生血栓后综合征(PTS)的差异.方法 回顾性收集2012年1月至2015年1月期间南充市中心医院收治的单侧下肢DVT患者,根据溶栓方式分为置管溶栓组和系统溶栓组,比较2组患者的近期血栓溶解率、溶栓并发症及随访5年时的PTS发生情况.结果 本研究共纳入...     

急性下肢深静脉血栓形成置管溶栓治疗与血栓形成后综合征的相关性研究

目的评价导管接触性溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)的疗效,并分析术后血栓形成后综合征(PTS)的发生情况。方法回顾性分析2012年5月~2015年5月期间我科收治的300例急性下肢DVT患者置管溶栓治疗的临床资料。通过静脉彩超联合造影术计算血栓溶解率评价手术早期疗效;通过6~24个月的静脉彩超联合造影术综合随访,分析患肢深静脉通畅率及Villalta评分测定PTS发生率及严重度,评价DVT经CDT治疗后与PTS发生的相关性。结果 300例患者有效溶解率(≥50%)为88.3%。术后3、6、12及24个月深静脉通畅率分别为95.0%、90.0%、85.0%及82.3%,术后12个月PTS发生率为15.0%。影响PTS发生的因素为DVT分型和分期:DVT中央型(OR=2.98)、混合型(OR=4.13);3天内(OR=3.05)、3天至2周(OR=2.72)。无手术相关严重并发症发生。结论CDT治疗急性下肢DVT疗效显著且安全,可以显著提高深静脉通畅率并降低PTS发生率;3天内的中央型DVT经CDT治疗疗效最好,基本上能够完全避免PTS发生。     

机械性血栓清除联合置管溶栓在下肢急性深静脉血栓治疗中的应用

目的探讨机械性血栓清除术(PMT)联合置管溶栓与单纯置管溶栓治疗下肢急性深静脉血栓的治疗效果与安全性。方法回顾性分析新疆维吾尔自治区人民医院血管外科2018年1月-2018年12月符合本研究纳入标准的69例下肢急性深静脉血栓患者的临床资料,其中男性35例,女性34例;平均年龄59岁,年龄范围20~80岁。按腔内溶栓方法不同,分为PMT联合置管溶栓组(n=38)及单纯置管溶栓组(n=31)。记录两组患者的溶栓时间、尿激酶用量、血栓清除率、患侧肢体周径变化值、围手术期间不良事件总数。患者出院后1个月、3个月、6个月时门诊复查下肢血管超声,检查并评估残余血栓溶解、血栓复发情况。计量资料以均数±标准差(Mean±SD)表示,采用t检验进行组间比较;计数资料采用百分比(%)表示,组间比较使用χ2检验。结果PMT联合置管溶栓组、单纯置管溶栓组溶栓时间分别为(3.7±2.1)d、(5.2±2.1)d,两组比较差异具有统计学意义(P=0.005),尿激酶用量分别为(225.0±122.3)万单位、(315.8±108.6)万单位,差异具有统计学意义(P=0.001)。PMT联合置管溶栓组Ⅰ级、Ⅱ级、Ⅲ级血栓清除率分别为18.4%(7/38)、73.7%(28/38)、7.9%(3/38);单纯置管溶栓组Ⅰ级、Ⅱ级、Ⅲ级血栓清除率为16.1%(5/31)、77.4%(24/31)、6.5%(2/31),比较两组患者Ⅰ级、Ⅱ级、Ⅲ级血栓清除率,差异均无统计学意义(P=0.803,P=0.720,P=0.818)。溶栓治疗48 h后,PMT联合置管溶栓组患侧大腿周径差为(2.16±0.87)cm、小腿周径差为(1.38±0.66)cm,单纯置管溶栓组患侧大、小腿周径差分别为(1.21±0.59)cm、(1.02±0.49)cm,两组患者溶栓治疗48 h后患侧大、小腿周径变化,差异具有统计学意义(P<0.001,P=0.014)。PMT联合置管溶栓组发生3例(7.89%)围手术期不良事件,单纯置管溶栓组4例(12.90%),差异无统计学意义(P=0.692)。两组患者共随访时间6个月,PMT联合置管溶栓组6个月随访率:71.05%(27/38),单纯置管溶栓组:64.52%(20/31),差异无统计学意义(P=0.532)。随访6个月期间PMT联合置管溶栓组血栓复发率为11.11%(3/27),单纯置管溶栓组为15.00%(3/20)。单纯置管溶栓组血栓复发率虽高于联合治疗组,但差异无统计学意义(P=0.693)。结论PMT联合置管溶栓与单纯置管溶栓治疗下肢急性深静脉血栓具有相似的临床效果,相比单纯置管溶栓,PMT联合置管溶栓可减少尿激酶剂量,缩短溶栓时间,具有短时间内缓解患肢肿胀的优势,近期随访疗效好。     

下肢深静脉血栓形成介入溶栓治疗的疗效

目的探讨下肢深静脉血栓形成(deep venous thrombosis)介入溶栓治疗的疗效。方法 2012年2月~2014年10月101例DVT可回收型下腔静脉滤器置入后经腘静脉顺行穿刺,置入溶栓导管,经溶栓导管尿激酶进行溶栓,通过溶栓导管造影了解血栓溶解情况,决定溶栓时间及尿激酶剂量。结果术后1周溶栓效果Ⅰ级87例(87/101,86.1%),Ⅱ级8例(8/101,8.0%),Ⅲ级6例(6/101,5.9%);痊愈80例(80/101,79.2%),有效21例(21/101,20.8%)。术后2周溶栓效果Ⅰ级95例(95/101,94.1%),Ⅱ级6例(6/101,5.9%);痊愈90例(90/101,89.1%),有效11例(11/101,10.9%)。5例复发2~3次,其中出院后1个月内3例复发,1~2个月内3例复发(1例第2次复发),2~3个月复发3例(1例第2次复发),3~6个月复发3例(2例第2次复发,1例第3次复发),以上5例考虑为易栓症,每次溶栓后治愈,长期口服华法林,并坚持定期门诊复查。截止2014年10月,101例随访3~30个月,平均10.7月,均未见支架移位、支架内血栓形成、狭窄、闭塞等。结论介入溶栓治疗具有有效预防肺栓塞、创伤小、痊愈快、卧床时间短及血栓后遗症明显减少等优点。