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。

Efficacy comparison of thrombus aspiration plus catheter directed thrombolysis and catheter thrombolysis alone for acute mixed deep venous thrombosis of lower extremities

Objective: To compare the efficacy of thrombus aspiration combined with catheter directed thrombolysis (CDT) and CDT alone in treatment of acute mixed lower extremity deep venous thrombosis (LEDVT). Methods: The clinical data of 121 patients with acute mixed LEDVT treated during June 2012 to June 2017 were retrospectively analyzed. Of the patients, 60 cases underwent CDT after thrombus aspiration (thrombus aspiration plus CDT group) and 61 cases underwent direct CDT (CDT alone group). The main clinical variables between the two groups of patients were compared. Results: The general preoperative data showed no significant differences between the two groups (all P>0.05). In thrombus aspiration plus CDT group compared with CDT alone group, the average length of hospital stay (6.2 d vs. 10.5 d, P<0.05) and average amount of urokinase used (17×104 U vs. 290×104 U, P<0.05) were significantly reduced. In thrombus aspiration plus CDT group and CDT alone group, the cure rate and effective rate in thrombus aspiration plus CDT group on one week after treatment were 75% and 91.67% and on two weeks after treatment were 83.33% and 96.72%, and in CDT alone group on one week after treatment were 45.9% and 91.67% and on two weeks after treatment were 62.3% and 96.72%, respectively. The cure rates in thrombus aspiration plus CDT group were significantly higher than those in CDT alone group (both P<0.05), but the effective rates showed no significant differences between the two groups (both P>0.05). Follow-up was conducted at 12 months after operation, the incidence of complications, the decreasing amplitudes in differences in the circumferences at 15 cm below the knee between healthy and affected limb, the vein patency rates and normal venous valve function rates as well as the overall effective rates showed no significant differences between the two groups (all P>0.05). Conclusion: Compared with CDT alone, thrombus aspiration plus CDT can obviously decrease the length of hospitalization, decrease the dose of urokinase infusion and increase the cure rate for acute mixed LEDVT, while its mid- and long-term efficacy shows no obvious superiority.