经皮穿刺胫前静脉入路导管溶栓治疗下肢深静脉血栓形成

Catheter-directed thrombolysis through anterior tibia veins for deep venous thrombosis

目的探讨经皮穿刺胫前静脉入路导管溶栓治疗下肢深静脉血栓形成(DVT)的临床应用价值。方法 10例下肢DVT患者,先行患肢深静脉顺行造影,明确诊断后,于患肢小腿中下段胫前区用4F穿刺针直接穿刺胫前静脉,置鞘后放置溶栓管于深静脉血栓段,行尿激酶持续泵入。结果10例DVT患者中,4例患者为中央型,6例为混合型。溶栓后深静脉主干再通,10例患者临床症状缓解,术后膝下小腿中段周径差平均(1.64±0.69)cm,与术前[(4.42±0.84)cm]比较差异有统计学意义(P【0.01)。患者均得到随访,随访时间4~10个月,7例肢体肿胀完全消退,2例有活动后轻度肿胀,1例在术后约2个月复发。结论经胫前静脉入路直接溶栓对于治疗下肢DVT是一种安全、有效的治疗方法。

Objective To evaluate clinical value of catheter-directed thrombolysis through anterior tibia veins for the treatment of deep venous thrombosis(DVT). Method A total of 10 patients with symptomatic DVT were reviewed. Anterograde angiography of deep vein of lower limbs was operated to make a definitive diagnosis. The anterior tibia vein of the symptomatic limb was punctured by a sheath in pretibial area, and then urokinase was continuously pumped through the Unifuse catheter beyond the thrombus. Results Among 10 patients with DVT, including central type in 4 cases and mixed type in 6 cases, deep vein trunks were repatent and clinical condition relieved. The difference of perimeter diffence of middle lower leg was statistically significant before [(1.64±0.69) cm] and after [(4.42±0.84)cm] operation( P<0.01). All patients were followed up with a time of 4~10 months. During the follow-up, swelling went down completely in 7 cases, slight swelling after activity occurred in 2 cases, and reoccurrence after operation 2 months occurred in 1 case. Conclusion Catheter-directed thrombolysis through anterior tibia vein for the treatment of DVT is safe and effective.