老年急性下肢深静脉血栓形成的临床治疗研究

目的：观察老年急性下肢深静脉血栓形成患者手术取栓和溶栓治疗的疗效，探讨其最佳治疗方法。方法老年急性下肢深静脉血栓形成患者245例，11例采用单纯手术取栓，84例采用杂交手术治疗，121例采用全身系统性药物溶栓，29例采用联合腔静脉滤器导管直接溶栓。结果186例患者获得随访，随访率75.9％，随访时间4-86个月，平均49个月。症状完全消失者中，单纯手术取栓组占27.2％（3/11），杂交手术治疗组占21.4％（15/70），导管直接溶栓组占50％（8/16），均高于全身系统性药物溶栓组13.1％（12/92）。全身系统性药物溶栓组肢体发生浅静脉曲张和皮肤色素沉着者占48.9％，均高于其他三组。结论手术取栓可以保护部分患者下肢的主干深静脉瓣膜，减少下肢深静脉血栓后综合征的发生率；联合腔静脉滤器导管直接溶栓是一种安全、有效的治疗方法，是治疗老年人下肢下肢深静脉血栓形成的首选方法。

Clinical treatment of acute lower extremity deep venous thrombosis in aged patients

Objective To observe the efficacy of embolectomy and thrombolysis for acute deep vein thrombosis of the lower extremity and to explore the optimal method. Methods A total of 245 aged patients with acute deep vein thrombosis of the lower extremity were enrolled. Eleven patients were treated by simple embolectomy,84 patients were treated by hybrid operation,121 patients were treated by thrombo-lytic agents and 29 patients were treated by catheter direct thrombolysis and vena cava filter. Results A total of 186 patients（75. 92%）were followed up. The follow-up time ranged from 4 months to 86 months, with an average of 49 months. The percentages of patients without symptoms were 27. 2%（3/11）in the simple embolectomy group,21. 4%（15/70）in the hybrid operation group,and 50%（8/16）in the catheter direct thrombolysis group,which were higher than the 13. 1%（12/92）in the thrombolytic agent group. In the thrombolytic agent group,patients with superficial varicosity and dermal pigmentation in the lower ex-tremity accounted for 48. 9%,which was higher than the other groups. Conclusion Embolectomy can pro-tect the valve of deep venous trunk in some patients and reduce the incidence of post-thrombotic syn-drome. Combined with vena cava filter,catheter direct thrombolysis is a safe and effective method,which is the priority for aged patients with acute deep vein thrombosis of the lower extremity.