经胫后静脉入路导管溶栓术治疗急性下肢深静脉血栓

目的 探讨经胫后静脉置管治疗急性下肢深静脉血栓的临床疗效及其临床应用价值.方法 回顾性分析新疆维吾尔自治区人民医院血管外科2013年10月-2015年1月收治的46例(男性30例,女性16例)急性下肢深静脉血栓行置管溶栓患者的临床资料,所有患者在下腔静脉滤器保护下,经患肢胫后静脉途径置入溶栓导管,持续溶栓、抗凝治疗.采用SPSS17.0进行统计学分析.计量数据以均数±标准差((x)±s)表示,溶栓前后比较采用配对t检验.检验水准α =0.05.结果 本组46例患者中,39例患者经置管溶栓患肢肿胀缓解,7例患者肿胀缓解欠佳,4例患者经对髂静脉球囊扩张后肿胀缓解,3例患者经对髂静脉球囊扩张及支架置入后肿胀缓解.治疗期间6例患者出现穿刺处渗血给予加压包扎,其余患者无并发症.置管溶栓后静脉通畅评分低,通常率高,溶栓前后比较差异有统计学意义(P＜0.05).溶栓前后下肢消肿率高,差异有统计学意义(P＜0.05).结论 经胫后静脉置管直接溶栓治疗下肢深静脉血栓能提高早期静脉通畅率,缩短肿胀缓解时间,是一种安全、有效的治疗方法.

Clinical research of catheter-directed thrombolysis for acute lower limb deep venous thrombosis by the posterior tibial vein

Objective To investigate the clinical efficacy and clinical value of catheter-directed thrombolysis for acute lower limb deep venous thrombosis by the posterior tibial vein.Methods Atotal of 46 patints with acute deep venous thrombosis in the department of vecular surgery of People's hospital of the xinjiang uygur autonomous region,under the protection of the inferior vena cava fillters,we treated by catheter directed thrombosisthrough the posterior tibial vein with urokinase continuous infusion.Results In the total gourp of 46 patients,39 patients effectively relieve the swelling,7 of which was ineffective,and 4 cases of patients ease the swelling after the expansion by the iliac vein balloon,3 patients accepted the iliac vein balloon dilation and stent placement,6 patients who were bleeding were treated with pressure dressing,andthere was no other complications.After the treatment,the venous patency score was low,and the patency rate was high and which have a statistical difference (P ＜ 0.05) before and after thrombolysis.Before and after thrombolytic therapy for lower limb swelling rate,there was statistically significant difference (P ＜ 0.05).Conclusions It is a safe and effective method to treat the deep venous thrombosis of lower limbs with catheter-directed thrombolysis by the protection of inferior vena cava filter.It can enhance the patency of the vein and shorten the swelling time.