经颈静脉导管血管内溶栓联合足背静脉溶栓治疗下肢深静脉血栓

Trans-jugular catheter-directed thrombolysis combined with trans-dorsalis pedis vein thrombolysis for the treatment of deep venous thrombosis of the lower limbs

目的探讨经颈静脉途径血管内溶栓联合足背静脉溶栓,治疗下肢深静脉血栓的可行性与疗效。方法18例下肢深静脉血栓患者(治疗组)采用经颈静脉穿刺后,置管造影并植入滤器,留置导管持续血管内溶栓同时联合足背静脉溶栓;而同期有16例患者(对照组)仅行足背静脉溶栓。结果治疗组溶栓时间为(6.6±2.3)d,对照组为(8.2±1.4)d;所用尿激酶总量治疗组为(552±224)万u,对照组为(700±166)万u。联合溶栓能显著减少溶栓时间与尿激酶用量(P<0.05)。治疗组溶栓前后大、小腿周径分别减小(4.6±2.1)cm、(4.0±2.1)cm,对照组分别为(3.2±1.7)cm、(2.7±1.5)cm,两组间差异有统计学意义(P<0.05)。治疗组完全溶通率为66.7%,对照组完全溶通率为31.3%,两组间差异有统计学意义(P<0.05)。治疗组4例患者在血栓完全溶通后从原穿刺处将滤器取出。结论经颈静脉途径导管内溶栓联合足背静脉溶栓治疗下肢深静脉血栓安全、效果好,完全溶通后可从原穿刺处回收滤器。

Objective To investigate the feasibility and efficacy of trans-jugular catheter-directed thrombolysis （CDT） together with trans-dorsalis pedis vein thrombolysis for the treatment of deep venous thrombosis （DVT） of the lower limbs. Methods Jugular vein puncture, indwelling catheter and placement of IVC filter were performed in 18 patients with DVT （study group） followed by continuous trans-jugular CDT together with trans-dorsalis pedis vein thrombolysis. During the corresponding period, 16 patients with DVT （control group） received trans-dorsafis pedis vein tbrombolysis only. Results The thrombolytic time and total dose of urokinase in study group and control group were （6.6 ± 2.3） days, （5.52 ± 2.24） × 10^6 units and （8.2 ± 1.4） days, （7.00 1.66） × 10^6 units respectively. The thrombolytic time and total dose of urokinase in study group were significantly lower than that in control group （P 〈 0.05）. After the treatment the thigh circumference and calf circumference in study group showed a reduction of （4.6 ± 2.1 ） cm and （4.0 ± 2.1） cm respectively, which were （3.2 ± 1.7） cm and （2.7 ± 1.5） cm respectively in control group, the difference between two groups was statistically significant （P 〈 0.05）. The complete patent of the veins was 66.7% in study group and 31.3% in control group, the difference between two groups was significant （P 〈 0.05）. In four cases of the study group, the filters were withdrawn through the original puncture site after the thrombus was completely dissolved. Conclusion Trans-jugular CDT combined with trans-dorsalis pedis vein thrombolysis is an effective and safe therapeutic technique for the treatment of deep venous thrombosis of the lower extremities, moreover, the filter can be taken back via the original puncture site when the thrombus is completely dissolved.