高频超声引导下经腘静脉穿刺置管溶栓治疗下肢深静脉血栓

目的探讨经腘静脉穿刺置管直接溶栓治疗下肢深静脉血栓(DVT)的应用价值。方法收集经CDFI或下肢深静脉造影确诊为DVT的36例患者。对观察组患者行超声引导下患侧腘静脉穿刺,置入溶栓导管,经导管持续灌注尿激酶溶栓;对照组采用经外周静脉滴注尿激酶,比较两组的治疗效果。结果观察组(16例)患者自治疗后第2天患肢肿胀开始减退,第4～6天时肿胀明显减退,治愈3例,显效11例,有效2例,总体有效率为100%(16/16);对照组(20例)自第2～4天起患肢肿胀开始减退,第7～9天明显减退,显效8例,有效6例,无效6例,总体有效率为70.00%(14/20);两组治疗效果的差异有统计学意义(Z=3.270,P=0.002)。溶栓治疗前后观察组肢体肿胀缓解程度较对照组明显,患肢大腿及小腿周径的差异均有统计学意义(P均<0.01)。结论于高频超声引导下经腘静脉穿刺置管直接溶栓治疗DVT安全、微创、疗效确切,且并发症少。

High frequency ultrasound-guided catheter-directed thrombolysis for lower extremity deep venous thrombosis via the popliteal vein

Objective To explore the application value of trans popliteal vein catheter-directed thrombolysis in patients with lower extremity deep venous thrombosis （DVT）. Methods Totally 36 patients with lower extremity DVT diagnosed by CDFI or deep venous angiography were enrolled. Patients in observation group were treated by catheter-directed thrombolysis with continuous infusion of urokinase after popliteal venous puncture under ultrasound guidance, while in the control group were treated by thrombolysis therapy with urokinase via peripheral vein. The efficacy of the two methods were compared. Results Limb swelling in the observation group （n=16） began to decline the 2nd day of treatment,and obviously reduced from the 4th to 6th day. In the observation group, 3 cases were cured, 11 were markedly effective, 2 were effective, and the overall efficiency was 100% （16/16）. In the control group （n=20）, limb swelling began to decline from 2nd to 4th day, and obviously decreased from the 7th to the 9th day. There were 8 cases of markedly effective, 6 effective, 6 ineffective, and the overall efficiency was 70.00%（14/20） of control group. There was statistical difference between the two groups （Z=3.270, P=0.002）. The degree of extremity swelling alleviated in the observation group was significantly larger than in control group before and after thrombolysis. The differences of thigh and calf circumference were statistically significant （both P〈0.01）. Conclusion High frequency ultrasound-guided catheter-directed thrombolysis for lower extremity DVT is safe and effective, with minimal invasion and fewer complications.