手术与非手术治疗下肢深静脉血栓形成疗效对比分析

Comparison of the effects of surgical versus non-surgical treatment for deep vein thrombosis of lower extremities

目的对比分析手术与非手术治疗下肢深静脉血栓形成(DVT)的疗效。方法将2002年8月至2006年3月重庆医科大学附属第二医院血管外科病房收治的127例8h至90d的中央型或混合型下肢DVT病人(患肢周径均大于健侧2cm以上),分为非手术治疗组60例,手术治疗组67例。手术组先置放下腔静脉滤器,然后行患肢取栓、球囊扩张、支架置放治疗。两组病人均经患肢行抗凝、溶栓等治疗。以治疗后彩色多普勒超声检查、患肢肿胀消退和胀痛缓解情况评价治疗效果。结果手术组总的疗效较非手术组好。手术组急性期与亚急性期的疗效相比差异无统计学意义,但均优于手术组慢性期。两组急性期的疗效差异无统计学意义,但亚急性期手术组疗效优于非手术组。结论下肢DVT急性期行非手术治疗可能更为合理,急性期未正规治疗的亚急性期中央型或混合型血栓适宜手术治疗。

Objective To compare the effects of surgical versus non-surgical treatment for deep vein thrombosis （DVT） of lower extremities. Methods One hundred and twenty-seven proximal or proximal and distal combined DVT patients were divided into surgical treatment group （67 patients） and non-surgical treatment group （60 patients）. The circumference of lower limb involving DVT in all patients were 2cm more than that of the other limb. The courses were from 8 hours to 90 days. The patients in the surgical group received thrombectomy ,balloon venoplasty ,and stent placement after placement of inferior vena cava filters. Two groups received anticoagulation and thrombolysis via limbs involving DVT. Color Doppler sonography and the edema fadeaway were used to evaluate the treatment effects. Results The effect of surgical treatment was superior to non-surgical treatment. The effects of acute and subacute patients in surgical group had no statistical difference, but that of acute and subacute versus chronic patients had statistical difference. The effects of acute patients in two groups had no statistical difference, but surgical treatment was superior to non-surgical treatment for subacute patients. Conclusions Non-surgical treatment may be proper for acute DVT of lower extremities. Surgical treatment is superior to non-surgical treatment for subacute proximal or proximal and distal combined DVT patients who received non- regularizing treatment in acute stage.