滤器保护下置管溶栓治疗下肢深静脉血栓形成临床总结

Catheter directed thrombolysis deep venous thrombosis of lower limbs under protection of vena cava filter.

目的探讨滤器保护下经胭静脉置管溶栓治疗下肢深静脉血栓形成的临床应用价值。方法对2002年12月至2005年2月收治的51例下肢深静脉血栓形成病人，在滤器保护下经B超引导，由胭静脉置入溶栓导管，以输液泵经溶栓导管持续泵入溶栓药物10—14d，同时行抗凝治疗。结果所有病人均置管成功，其中3例未能通过髂静脉。临床表现均有不同程度的好转，出院前均行影像学检查，治愈11例，显效34例，有效6例。其中5例接受髂静脉球囊扩张术，3例行髂静脉支架置入术，1例行耻骨上静脉转流术。结论下腔静脉滤器保护下行膪静脉置管溶栓，可防止肺栓塞，延长尿激酶溶栓时间窗，减少尿激酶用量，减少出血并发症，并为后续治疗提供机会。

Objective To discuss the feasibility of catheter directed thrombolysis deep venous thrombosis of lower limbs under protection of vena cava filter. Methods Fifty-one cases of deep venous thrombosis of lower limbs from December 2002 to February 2005 were treated with catheter directed thrombolysis, the popliteal puncture under ultrasound guidance for the venous access,and the course of therapy was continued 10 - 14 days with anticoagulation. Results The procedures of the popliteal puncture and catheter and guidewire exchanges were successful in all 51 cases,and were not permitted passing through iliac veins in 3 cases. Clinical manifestations were alleviated in all 51 cases. Implied by imaging examination before discharged from hospital, 11 cases were completely cured, significantly improved in 34 cases,and improved in 6 cases. There were 5 cases accepted balloon dilatation in iliac venous, 3 cases accepted iliac venous stent, 1 case accepted by-pass surgery. Conclusion The catheter directed thrombolysis deep venous thrombosis of lower limbs under protection of vena cava filter can prevent pulmonary embolism, prolong the time of thrombolysis, decrease the dosage of u- rokinase and complication of hemorrhage,and it can take the chance of subsequent therapy.