腔静脉滤器植入、溶栓及手术治疗下肢深静脉血栓形成

Treatment of Lower Extremity Deep Venous Thrombosis with IVC Filter Placement,Embolectomy and Thrombolytic Therapy

目的:探讨下肢深静脉血栓形成的有效治疗方法。方法:回顾性分析1988年4月-2006年10月间治疗的255例下肢深静脉血栓形成的临床资料。直接患肢深静脉溶栓74例,手术取栓12例,抗凝等治疗169例,下腔静脉滤器植入32例(均为永久性滤器)。结果:随访2～126个月,平均64个月。31只下腔静脉滤器均展开良好,有1例临时滤器移位至下腔静脉近心端,其他无移位。1例永久性滤器植入14个月后滤器中血栓形成。溶栓组显效52例,有效20例,无效2例。手术组显效10例,有效2例,无效0例。两种治疗方法比较,显效率有显著差别(P＜0．05),总有效率无显著差别。结论:腔静脉滤器植入能有效预防肺动脉栓塞,但应严格掌握适应证。手术治疗是提高疗效和预防后遗症的有效方法。

Objective： To investigate the feasible and effective methods for the treatment of lower extremity deep venous thrombosis. Methods： The clincal data of 255 cases of lower extremity deep venous thrombosis were analysed retrospectively from April 1988 to October 2006. Antegrade infusion of high dose urokinase was performed via the dorsalis pedis vein of the involved lower limb in 73. patients; Embolectomy, in 73. patients; and Anticoagulation et al in 169 patients. VenaTechTM LP or Cordis was placed in 32patients. Results： The period of the follow up ranged from April 1988 to October 2006, with an average of 63, months. All the 31 IVC filters were successfully deployed, but only 1 Temporary-filter Ⅱ was migrated to proximal IVC. VenaTeehTM LP occlusion in one case ocurred 14 months after IVC filter was placed. 52 cases were cured, 20 improved, yet 2 still ineffective. In postoperative group, 10 were cured, 2 improved, and 0 ineffective. The cure rate of postoperative group was better than that of the thrombolytic group（ P 〈0.05 ）. But the total effective rate of the postoperative group was similar to the thrombolyfic group. Conclusions： Vena cava filter implantation can prevent the patients from pulmonary embolism effectively. But the indication should be stricdy controlled. Surgical management is an effective method for the treatment and the prevention of later complication of lower extremity deep venous thrombosis.