围产期孕产妇急性下肢深静脉血栓形成的介入治疗

目的探讨介入治疗围产期合并下肢深静脉血栓形成患者的临床应用价值。方法收集围产期合并急性下肢深静脉血栓形成孕产妇13例,其中6例孕妇,7例产妇。采用改良Seldinger穿刺技术经健侧股静脉或右侧颈静脉入路,7例产妇行腔静脉滤器置入,6例晚期妊娠患者于下腔静脉内置入滤器后终止妊娠;13例患者均行全身或患侧静脉内置管抗凝溶栓处理,溶栓过程中观察凝血功能变化及临床症状改善情况,疗效满意后行腔静脉滤器回收并随访6个月。结果 13例患者中11例患肢完全消肿,胀痛消失,超声提示下肢深静脉血栓消失,2例患者患肢轻度水肿,胀痛缓解,超声提示仍有部分附壁血栓,治疗过程中未发现患者发生出血,13枚下腔静脉滤器全部成功回收;随访中孕产妇及新生儿均未发现与辐射有关并发症发生,无血栓再发。结论局部置管溶栓联合腔静脉滤器置入是治疗围产期急性下肢深静脉血栓形成的安全有效方法。

Interventional therapy for acute deep venous thrombosis of lower limbs of perinatal period women

Objective To explore the clinical value of interventional therapy for acute deep venous thrombosis of lower limbs of perinatal period women. Methods Thirteen patients with acute deep venous thrombosis of lower limbs were collected, with six pregnant woman and seven parturient. The improved Seldinger＇s technique was taken. The catheter was inserted in veins of lower extremity＂ or inferior vena cava of affected side via uninjured femoral vein or right jugular vein. Six late pregnancy women were terminated pregnancy after inferior vena cava fiher was placed;seven parturient were placed inferior vena cava filter. All patients were handled with thrombolytic therapy in total body or affected vein. The blood coagulation function and improvement of clinical symptoms was observed. Inferior vena cava filters were recovered after obtaining satisfying curative effect and followed up for six months. Results The swelling and pain disappeared in eleven patients and the ultrasound showed that the thrombus of deep veins of lower limb disappeared. Two patients still with slightly edema, and gas pains relieved ; the ultrasound showed that still had some mural thrombus. No patient was found with bleeding. Thirteen inferior vena cava filters were recovered successfully. Complication related to radiation were not found in all pregnant women and newborns and deep vein thrombosis not recurred. Conclusion Local transcatheter thrombolysis combined with inferior vena cava filter placement is a safe and effective method for the treatment of perinatal acute deep venous thrombosis of lower limbs.