经腘静脉置管接触性溶栓治疗急性下肢深静脉血栓形成应用价值研究

目的探讨经患侧腘静脉置管接触性溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)的临床疗效。方法回顾性分析自2012年3月至2017年3月收治的39例应用经患侧腘静脉CDT治疗急性DVT患者的临床资料。所有患者均在腔静脉滤器保护下经患侧腘静脉置管CDT。记录置管成功率,健、患肢周径差值,静脉血栓评分,静脉再通率,深静脉瓣膜保存率,介入治疗并发症与下肢深静脉血栓形成后综合征(PTS)的发生率等指标并评价疗效。结果所有患者均穿刺置管成功,置管成功率为100.0%(39/39)。患者治疗前后的健、患肢周径差值分别为(6.12±1.03)cm与(2.55±0.76)cm,差异有统计学意义(P<0.05),肢体肿胀消退明显。患者治疗前后静脉血栓评分为(5.73±0.94)分与(2.13±1.60)分,差异有统计学意义(P<0.05),血栓消融明显,静脉再通率为(64.23%±16.21%)。39例患者中,1例患者出现置管处炎症,1例患者出现穿刺处血肿,1例患者溶栓后出现髂静脉狭窄并行髂静脉支架植入术治疗,即介入治疗并发症的发生率为7.7%(3/39)。随访6~12个月,34例患者完成随访,随访率为87.2%(34/39),无DVT复发与肺栓塞发生。深静脉瓣膜保存率为(76.14%±9.15%),PTS的发生率为15.4%(6/39)。结论应用经患侧腘静脉CDT治疗急性DVT安全有效。

Via the popliteal venous catheter-directed thrombolysis for deep venous thrombosis of acute lower extremity

Objective To evaluate the clinical effect of popliteal venous catheter-directed thrombolysis(CDT)in the treatment of acute deep venous thrombosis(DVT)in the lower extremity. Methods A retrospective study was performed on 39 cases of patients with a-cute DVT who were treated by CDT via popliteal venous from March 2012 to March 2017. All patients were treated by CDT via the popliteal venous after placement of vena caval filter. The success rate of catheter,the perimeter differences of the normal and affected lower limbs before and after treatment,the score of venous ventilation,the limb deep vein patency rate,deep vein valve retention rate, complications of interventional therapy and the incidence of post-thrombotic syndrome(PTS)were calculated to evaluate the efficacy. Results All patients had successful puncture catheter,and the success rate of catheter was 100. 0％ . The perimeter differences of the normal and affected lower limbs before and after thrombolytic therapy was(6. 12 ± 1. 03)cm versus(2. 55 ± 0. 76)cm,respectively (P < 0. 05),and the swelling of the limbs were subsided significantly. The score of venous thrombus before and after the treatment was (5. 73 ± 0. 94)scores and (2. 13 ± 1. 60)scores,respectively(P < 0. 05);the ablation of thrombus was obvious,and the rate of ve-nous regeneration was(64. 23％ ± 16. 21％). Among 39 cases,1 case had inflammation in the place of catheter tube,1 case had hema-tomas in the puncture site and 1 case had iliac vein stent implantation after thrombolysis when iliac vein stenosis was found,the com-plications of interventional therapy was 7. 7％(3 / 39). During the period of 6 to 12 months of follow-up,34 cases were accomplished, and the follow-up rate was 87. 2％(34 / 39). No DVT recurrence or pulmonary embolism(PE)occurred. The preservation rate of deep vein valve was(76. 14％ ± 9. 15％),the incidence of PTS was 15. 4％(6 / 39). Conclusion The CDT via popliteal venous for acute DVT is safe and effective.