经腘静脉插管定向溶栓治疗下肢深静脉血栓形成的临床研究

Catheter-directed thrombolysis through popliteal vein for the treatment of lower extremity deep venous thrombosis

目的评价腘静脉插管定向溶栓治疗下肢深静脉血栓的疗效。方法 62例下肢深静脉血栓患者,行患肢腘静脉穿刺插管,在可视条件下将导管插入至血栓近心端,经导管首次推注尿激酶20万单位后,持续注射尿激酶10万单位／h溶栓,同时每12 h皮下注射低分子肝素钠400 U。以下肢肿胀消退情况评价疗效,以深静脉造影评价溶栓效果。结果经导管溶栓治疗不仅使深静脉血栓部分或完全消融,而且侧支循环开放较治疗前显著增加。患肢总消肿率(78±22)％,总溶栓率(67± 27)％,其中急性、急慢性和慢性病例溶栓率分别为75％、71％,49％,前两者显著高于后者(P< 0．05)。21例患者血栓完全消融,无严重并发症发生。结论 腘静脉插管定向溶栓治疗下肢深静脉血栓形成能够快速溶解血栓,恢复深静脉血流通畅,患者临床症状改善效果满意,治疗方案安全可靠。

Objective To evaluate catheter-directed thrombolysis through popliteal vein for the treatment of lower extremity deep venous thrombosis （DVT）. Method A total of 62 patients with single symptomatic lower limb DVT were analyzed. The popliteal vein of symptomatic limb was punctured, under Doppler guidance a 5-F sheath was advanced into the deep vein. A catheter was advanced beyond the thrombus. After a bolus of 200 000 IU urokinase, 100 000 IU/h urokinase was infused for up to three days, meanwhile 400 IU heparin was administered subcutaneously every 12 h. Clinical efficacy grade was evaluated by measuring the perimeter of legs and lysis grade was calculated based on venographic results. Results In addition to total or partial removal of the thrombus collateral circulation increased, the limbs edema reduction rate was 78% and the thrombolysis rate was 67%. Thrombolysis rate in acute, and relapsing cases was significantly higher than in chronic group （75%, and 71% vs. 49%, P 〈 0.05）. Complete thrombolysis occurred in 21 cases. There were only three minor complications, including one calf hematoma and two minor bleeding at punctual site. Conclusion Catheter-directed thrombolysis with transpopliteal vein access for the treatment of acute DVT is safe and effective.