不同方式治疗急性深静脉血栓形成的临床效果和安全性

目的评价单纯抗凝治疗与腔内治疗对急性髂-股静脉血栓形成（I-FVT）的临床效果和安全性。 方法收集2015年1月至2016年9月在新疆维吾尔自治区人民医院接受治疗的142例I-FVT患者，其中接受单纯抗凝治疗40例（抗凝组），腔内治疗102例（导管溶栓、机械性血栓吸除及机械性血栓吸除联合导管溶栓；腔内组）。比较2组治愈率、有效率、血栓清除程度、不良事件发生情况等。 结果腔内组治愈率（膝上：58.8% vs 12.5%，膝下：53.9% vs 10.0%）、有效率（膝上：96.1% vs 65.0%，膝下：97.1% vs 75.0%）、血栓清除程度（出院时：χ²=75.754，P<0.001；随访3个月：χ²=26.366，P<0.001）均高于抗凝组，差异均具有统计学意义。随访3个月，腔内组7例出现穿刺点血肿，13例发生血尿，2例对侧肢体继发性血栓形成，1例发生对比剂相关性肾病；随访6、12、24个月，腔内组患肢DVT的复发率（7.8% vs 22.5%，12.7% vs 27.5%，18.4% vs 37.8%）、PTS发生率（15.7% vs 37.5%，20.6% vs 42.5%，25.5% vs 54.1%）、Villalta评分［（2.24±2.13）分vs （5.15±2.93）分，（3.32±2.88）分vs （6.90±4.07）分，（4.22±3.93）分vs （8.11±4.85）分］明显低于抗凝组，差异具有统计学意义（P<0.05）。 结论腔内治疗急性I-FVT的疗效明显优于单纯抗凝治疗，但腔内有创操作伴随较多不良事件发生。

Clinical effects and safety of anticoagulation and endovascular therapy for acute deep venous thrombosis

ObjectiveTo investigate the clinical effects and safety of anticoagulation and endovascular therapy for acute iliac-femoral venous thrombosis (I-FVT). MethodsA total of 142 patients who were definitely diagnosed with acute I-FVT were included from January 2015 to September 2016 in Xinjiang Uygur Autonomous Region People′s Hospital, including 40 cases undergoing anticoagulant therapy, (anticoagulation group) and 102 cases undergoing percutaneous endovascular therapy [endovascular therapy group; catheter directed thrombolysis (CDT), percutaneous mechanical thrombus removal (PMT), and PMT combined with CDT]. The cure rate, effective rate, and the degree of thrombus removal were compared between the two groups. The incidence of adverse events during treatment and the follow-up period was recorded. ResultsThe cure rate (above knee: 58.8% vs 12.5%; below knee: 53.9% vs 10.0%), effective rate (above knee: 96.1% vs 65.0%; below knee: 97.1% vs 75.0%), and degree of thrombus removal differed significantly between the endovascular therapy group and anticoagulation group (P<0.001). During the 3-month follow-up period, there were 7 cases of puncture site hematoma, 13 cases of hematuria, 2 cases of secondary thrombosis of contralateral limbs, and 1 case of contrast-related nephropathy in endovascular therapy group. During the 6-, 12-, 24-month follow-up periods, the recurrence rate of deep venous thrombosis (7.8% vs 22.5%, 12.7% vs 27.5%, 18.4% vs 37.8%), the incidence of post-thrombotic syndrome (15.7% vs 37.5%, 20.6% vs 42.5%, 25.5% vs 54.1%), and Villalta score [(2.24±2.13) vs (5.15±2.93), (3.32±2.88) vs (6.90±4.07), (4.22±3.93) vs (8.11±4.85)] were significantly lower in the endovascular therapy group than in the anticoagulant therapy group (P<0.05). ConclusionEndovascular therapy for acute I-FVT has better efficacy than anticoagulation treatment alone, but endovascular therapy is invasive with more adverse events.