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。

Comparison of clinical effects between fogarty catheter thrombectomy and pharmacal thrombolysis for acute iliofemoral lower extremity deep vein thrombosis

Objective To investigate the clinical efficacy on treatment of acute iliofemoral lower extremity deep venous thrombosis with fogarty catheter thrombectomy and pharmacal thrombolysis. Methods The clinical data of 175 cases with lower extremity iliofemoral deep venous thrombosis were analysed retrospectively from March 2000 to January 2008. There were 85 patients were treated by fogarty catheter thrombectomy. Among them there were 23 cases with common iliac vein was occlusion or stenosis.Urokinase or low molecular weight heparin was used for thrombolysis and anticoagulation after operation.The other 90 patients were treated by pharmacal thrombolysis, including urokinase and low molecular heparin,Results No significant differences were found in the course of the disease and swelling between two groups before treatment（P〉0.05）. After treatment for 1 month, the circumferential difference between bilateral limbs was reduced from （4.3±1.6）cm to （0.8±0.5）cm in operation group, and declined from （4.0±1.9）cm to （1.8±1.3）cm in thrombolysis group.The cure rate was 71.8% in thrombectomy group and 38.9% in thrombolysis group （χ2=5.362,P=0.021）.70.9% patients were followed up for average （28.5±11.3）months. The circumferential difference between bilateral limbs was（0.5±0.2）cm in thrombectomy group and （1.2±0.5）cm in thrombolysis group respectively.The cure rate was 75.8% in thrombectomy group and 45.9% in thrombolysis group（χ2=11.556,P=0.001）.In surgical group the incidence of deep venous thrombosis sequelae was less than that thrombolysis group （P〈0.05）.In the incidence of venous valve dysfunction, the thrombectomy group was less than that thrombolysis group （P〈0.05）, Conclusion Fogarty catheter thrombectomy was more effective than pharmacal thrombolysis in the treatment of acute iliofemoral deep venous thrombosis.