下腔静脉滤器植入、溶栓、手术治疗下肢深静脉血栓形成

目的：探讨下肢深静脉血栓形成（DVT）的有效治疗方法。方法 ：回顾性分析近9年来治疗的211例下肢DVT的临床资料。直接患肢深静脉溶栓179例，其中下腔静脉滤器植入29例（临时性滤器5例，永久性滤器24例）；下腔静脉滤器植入并手术（取栓、球囊扩张、支架植入、髂静脉成型）32例，其中植入临时性滤器6例，永久性滤器26例。结果： 146例（68.7%）随访3~108个月，平均54个月。61只下腔静脉滤器均展开良好，有1例临时滤器移位至下腔静脉近心端，其他无移位。临时滤器体内置放2~4周取出。1例永久性滤器植入14个月后滤器中血栓形成。溶栓组显效87例，有效86例，无效6例。手术组显效28例，有效3例，无效1例。手术组显效率显著高于溶栓组（P<0.05），但总有效率差别无显著性（P>0.05）。结论：下腔静脉滤器植入能有效预防肺动脉栓塞，但应严格掌握适应证。手术综合治疗是提高疗效和预防下肢DVT后遗症的有效方法。

Treatment of lower extremity deep venous thrombosis with IVC filter placement,embolectomy and thrombolytic therapy

Objective:To investigate the feasible and effective means for the lower extremity deep venous thrombosis(DVT).Methods :The clincal data of 211cases of lower extremity DVT treated in recent 9 years were analysed retrospectively.Antegrade infusion of high dose urokinase was performed via the dorsalis pedis vein of the involved lower limb in 179 patients.Of the 179 patients vena cava filters(VCF) was placed in 29 patients,including Tempofilter II VCF in 5patients, VenaTechTM LP VCF in 24patients.Other 32 cases underwent embolectomy after IVC filter placement(Tempofilter II was placed in 6patients, VenaTechTM LP was placed in 26patients). Results: 146 patients were followed up for 3 108 months with averge 54months .A total of 61 IVC filters were successfully expanded,but 1 Tempofilter II VCF was migrated to proximal end of IVC.Tempofilter II VCF was taked out 2 4 week after the IVC filter placement . VenaTechTM LP occlusion in one case 14 months after the IVC filter placement.In thrombolytic group,87were cured,86 improved,6 ineffective. In operative group, 28were cured,3 improved,1 ineffective. The cured rate in operative group was better than that in thrombolytic group(P<0.05),but the total effective rate was similar in both groups.Conclusions: Vena cava filters placement can effectively prevent the formation of pulmonary embolism, but the indication should be strict.Combination of surgery with other therapy is effective in improving the results and preventing the sequela of lower extremity DVT.