双介入方法治疗下肢深静脉血栓并发急性肺栓塞：附21例报告

目的：探讨应用双介入方法治疗下肢深静脉血栓（LEDVT）并发急性肺栓塞（APE）的效果。方法：回顾性分析2010年1月—2013年5月对21例LEDVT并发APE患者行下腔静脉滤器植入，肺动脉导管碎栓、溶栓及患肢深静脉置管溶栓治疗的临床资料。APE发生部位：肺动脉主干2例、左肺动脉8例、右肺动脉6例、叶肺动脉5例；LEDVT发生部位：左侧9例、右侧12例。结果：21例患者均完成肺动脉及下肢深静脉双介入治疗。术中即刻造影显示2例肺动脉主干完全开通，左/右肺动脉干8例完全开通，6例大部分开通，5例叶肺动脉部分开通。肺动脉压由（52±7）mmHg降至（27±4）mmHg，PaO2由（62±6）mmHg升至（82±6）mmHg（均P<0.01）。患肢血管彩超检查示血栓均有不同程度溶解，血流全部或部分恢复。健患侧膝上、下15 cm周径差分别由（9.0±4.0）cm和（5.0±2.0）cm降为（2.3±0.9）cm和（1.0±0.7）cm（均P<0.01）。结论：对LEDVT并发APE患者的双介入治疗可以迅速恢复肺灌流量，纠正低氧血症，改善全身情况，以及溶解患肢深静脉血栓，改善肢体循环，减轻肢体症状，减少深静脉血栓后遗症。

Double intervention for lower extremity deep vein thrombosis with secondary acute pulmonary embolism: a report of 21 cases

Objective: To assess the efficacy of double intervention approach in treatment of lower extremity deep vein thrombosis (DVT) complicated with acute pulmonary embolism (PE).Methods: The clinical data of 21 patients with lower extremity DVT and secondary acute PE, who underwent inferior vena cava filter placement with pulmonary artery catheter-directed fragmentation and thrombolysis, and in combination with catheter-directed thrombolysis of the affected lower extremity deep vein from January 2010 to May 2013, were retrospectively analyzed. PE was located in the main trunk of pulmonary artery in 2 cases, in the left pulmonary artery in 8 cases, in the right pulmonary artery in 6 cases, and in the lobar pulmonary artery in 5 cases.Results: The double intervention treatment was completed in all the 21 patients for dealing with their pulmonary arteries and lower extremity deep veins. Intraoperative immediate angiography showed the main trunk of pulmonary artery in the 2 cases was fully opened, and left or right pulmonary arteries were fully opened in 8 cases and largely opened in 6 cases, and the lobar pulmonary arteries in 5 cases were partially opened. Pulmonary arterial pressure was decreased from (52±7) mmHg to (27±4) mmHg, and PaO2 was increased from (62±6) mmHg to (82±6) mmHg (both P<0.01). Vascular doppler ultrasound examination showed that all the clots in the affected limbs were dissolved in varying degrees, with a partial or complete restoration of blood flow. The circumference differences 15 cm above and below the knee joint between the healthy and affected limb decreased from (9.0±4.0) cm and (5.0±2.0) cm to (2.3±0.9) and (1.0±0.7) cm, respectively (both P<0.01).Conclusion: For patients with lower extremity DVT and secondary acute PE, the double intervention approach can quickly restore pulmonary flow, correct hypoxemia, and improve the general condition of these patients, as well as dissolve the deep vein thrombus, improve circulation and reduce symptoms in the affected limb, and reduce the sequelae of DVT.