早期下肢深静脉血栓非手术治疗412例分析

Non-surgical therapy for 412 patients with early lower extremity deep venous thrombosis

目的探讨早期下肢深静脉血栓形成（DW）的非手术治疗效果及并发症。方法回顾分析我院2000年1月至2006年12月412例行溶栓、抗凝治疗并随访的早期DW病例的临床资料。结果随访时间12～83个月。痊愈42例（10．2％），显著好转331例（80．3％），好转32例（7．8％），无效7例（1．7％），总有效率98．3％。病程≤7d者痊愈率、好转率明显高于〉7d者（11．0％与5．4％，X^2=4．17，P〈0．05；8．7％与1．8％，X^2=4．96，P〈0．05）。出血2．2％，肺栓塞1．9％，脑卒中0．7％，血栓后遗症84．0％，复发6．1％。≥60岁患者出血发生率显著增加（4．3％与0．8％，X^2=6．82，P〈0．01）；病程〉7d者血栓后遗症发生率高于≤7d者（98．2％与81．7％，X^2=3．67，P〈0．05）。结论以溶栓和抗凝为主的非手术治疗对绝大多数患者安全、有效，早期诊断和治疗是提高疗效和减少血栓后遗症的关键。

Objective This report was to discuss the efficacy and complications of non-surgical therapy for patients with early lower extremity deep vein thrombosis. Methods A total of 412 patients were treated with thrombolysis or anticoagulation in our department during January 2000 and December 2006. Their clinical data were retrospectively analyzed. Results All patients were followed up for 12 to 83 months （mean, 41 months）. After treatment, 42 patients （10.2%） were completely recovered, 331 patients （80. 3%） experienced large improvement, 32 patients （7.8%） had mild improvement and 7 patients （ 1.7% ） were failed, resulting in total effective rate of 98.3%. In comparison with long clinical course group （ 〉7 days）, the recovery rate and improvement rate of short clinical course group （≥7 days） was significantly increased （ 11.0% vs 5.4%, X^2 = 4. 17, P 〈 0. 05 ; 8.7% vs 1.8%, X^2 = 4. 96, P 〈 0. 05）. Complications included bleeding （ 2. 2% ）, pulmonary embolism （ 1.9% ）, cerebral accident （ 0. 7% ）, post-thrombotic syndrome （84.0%） and recurrence （6. 1% ）. Bleeding rate in patients ≥ 60 years was significantly higher （4.3% vs 0.8%, X^2 = 6. 82, P〈0. 01 ）. Incidence of post-thrombotic syndrome was significantly increased in long clinical course group （98.2% vs 81.7%, X^2 = 3.67, P〈0.05）. Conclusions Non-surgical therapy, including thrombolysis and anticoagulation, might be safe and effective for patients with early lower extremity deep vein thrombosis. Early identification and management would be helpful to improve outcomes and reduce post-thrombotic syndrome.