经动脉置管持续性溶栓治疗下肢深静脉血栓形成

Intra-arterial contimuous thrombolytic therapy for lower extremity deep vein thrombosis

目的评价动脉置管持续溶栓治疗急性下肢深静脉血栓形成(LEDVT)的效果。方法68例急性LEDVT患者随机分为两组:经动脉置管溶栓组(A组,n=37)和经静脉溶栓组(B组,n=31)。监测治疗前后PT,FIB,D-两聚体及健、患肢周径,以治疗前、后周径差的减小判断肢体肿胀的缓解程度;通过静脉造影或彩超,以静脉通畅度评分和静脉通畅改善度指标评价疗效。结果A组治疗过程中无出血发生,B组4例出现不同程度的出血。两组治疗后均出现PT延长、FIB降低、D-两聚体减少,与治疗前比较,差异均有显著(P<0.05),但两组间差异无显著性(P>0.05)。两组溶栓后肢体肿胀缓解程度A组大于B组(P<0.01)。A组通畅改善度为(54.81±3.21)%,B组通畅改善度为(31.52±3.89)%,两者差异有显著性(P<0.01)。结论经动脉置管溶栓治疗急性LEDVT是一种安全有效的方法。

Objective To evaluate intra-artery transcatheter thrombolytic therapy for the treatment of acute lower extremity deep vein thrombosis （ LEDVT ）. Methods A total of 68 patient with LEDVT were randomly divided into two groups to respectively receive intra-artial transcatheter thrombolysis （ Group A ） , or intra-venous thrombolysis （Group B ）. The PT, FIB, D-dimer and the perimeter of limbs were examined and measured before and after treatment, the circumference difference between normal and affected limbs was measured to assess the reduction of edema, and the venous patency score and the patency improvement were observed by venograms or Duplex. Results No haemorrhage occurred during the treatment in Group A, but 4 patients in Group B had clinical haemorrhage. After treatment, increase of PT, and decrease of FIB and D-dimer was found in both groups （ P 〈 0.05 ） . The reduction of edema in Group A after treatment was significantly more than that in Group B （ P 〈 0.01 ） , and the mean rate of venous patency improvement was also significantly different （ P 〈 0. 01 ） between the two groups [ Group A （ 54. 81 ± 3. 21 ） % , Group B （31.52 ± 3. 89 ）% ]. Conclusions The preliminary experience suggests that intra-arterial transcatheter thrombolytic therapy is a safe and effective treatment for acute LEDVT.