经导管血栓清除联合溶栓治疗髂股静脉血栓

Transcatheter Clearing Thrombosis Combined with Continuous Thrombolytic Therapy for Iliofemoral Venous Thrombosis

目的 探讨经导管血栓清除术联合尿激酶 (UK)持续溶栓治疗髂股静脉血栓的疗效和安全性。资料与方法 13例患者经血管造影证实为髂静脉血栓。经健侧股静脉穿刺置管 ,行下腔静脉 (IVC)滤器置入术 ,再顺静脉血流穿刺患侧股静脉 ,成功后 ,综合运用球囊导管扩张和拖拉、大腔导管负压抽吸等技术 ,以及冲击溶栓等方法对髂静脉血栓进行清除 ,直到满意为止。再逆静脉血流穿刺股静脉 ,进行股静脉血栓清除术 ,具体操作同髂静脉血栓清除术。最后 ,将溶栓导管留置股静脉血栓远端 ,进行UK后续持续溶栓。间隔 2 4～ 72h造影复查 ,并结合临床表现决定是否继续行血栓清除和持续UK溶栓治疗。溶栓期间 ,每隔 4～ 6h监测纤维蛋白原 (FIB)、部分凝血酶时间(PT)、白陶土部分凝血酶时间 (APTT)值 ,同时观察股静脉穿刺留置导管处的出血情况和生命体征。结果 13只IVC滤器置入位置均在右肾静脉下方 1～ 2cm ,展开良好。患侧股静脉首次穿刺置管成功 12例 ,失败 1例 ,成功率92 .3% (12 / 13)。 13例患者均接受 1次以上血栓清除术 ,共 36次 ,平均 2 .8次。UK持续溶栓维持 3～ 14d ,平均 9d。痊愈 2例 ,显效 9例 ,有效 2例 ,无效 0例。患者住院期间 ,未出现肺动脉栓塞症状及严重出血现象 。

Objective To explore the efficacy and safety of transcatheter clearing thrombosis in combine with thrombolytic therapy via catheter direct continuous effusing UK treatment for the iliofemoral venous thrombosis (IFVT).Materials and Methods Thirteen IFVT patients confirmed by angiography were planted inferior vena cava (IVC) filter via puncturing thigh vein in the health side before the thrombosis removal and thrombolytic therapy. Then dilation and drag by the balloon catheter and negative press pump by large catheter combined thrombolytic therapy effused by UK through puncturing the thigh vein in the ill side were carried out in 13 IFVTT patients. At last, the catheter direct continuous effusing UK was performed through the thrombolytic therapy catheter. The blood coagulation function and life condition were monitored and the angiography was performed repeatedly during the thrombolytic therapy.Results 13 IVC filter located in right kidney vein 1～2 cm below. The successful rate of the ill side thigh vein puncturing was 92.3%(12/13) for the first time, 1 failure patient was carried out thigh artery indwelling cathether continuous thrombolytic therapy and after 2 days the ill side thigh vein puncturing was successful. The mean thrombosis clearing procedure times and the thrombolytic therapy lasting time were 3.8 and 9 days, respectively. The total efficacy rate was 100% (CR 1 case, PR 12 cases). No serious complication was seen during the thrombosis clearing procedure and the thrombolytic therapy. Following up 1～3 months (mean 5 months). Recurrence of the IFVT and symptom and shift or perforation of the IVC filters were not found in 13 patients.Conclusion Transcatheter clearing thrombosis combine with thrombolytic therapy via catheter direct continuous effusing UK treatment for the IFVT is a safe and effective. The IVC filter placement can avoid pulmonary embolization before the clearing thrombosis or thrombolytic therapy.