系统治疗下肢深静脉血栓形成1455例临床分析

Synthesizing therapy for deep vein thrombosis of the lower extremity(Report of 1455 cases)

目的探讨下肢深静脉血栓形成(DVT)的有效治疗方法。方法回顾性分析1993年1月-2008年11月间治疗的1455例下肢DVT的临床资料,直接患肢深静脉溶栓1379例,其中下腔静脉滤器植入22例(临时性滤器6例,永久性滤器16例)。下腔静脉植入并手术治疗76例(取栓、球囊扩张、支架植入、髂静脉成型),其中下腔静脉植入临时性滤器5例,永久性滤器61例。结果随访3个月～15年,溶栓组显效705例,有效648例,无效26例。手术组显效67例,有效7例,无效2例。手术组显效率显著高于溶栓组(P<0.05),但总有效率差别无显著性(P>0.05)。肺拴塞死亡18例。98支下腔静脉滤器均展开良好,有2例临时滤器移位至下腔静脉近心端,其他无移位。临时滤器体内置放2周～4周取出,8例永久性滤器植入14个月后滤器中发现血栓形成并机化。结论下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,手术综合治疗是提高疗效和预防下肢DVT后遗症的有效方法。

Objective To investigate the feasible and effective means for the lower extremity deep venous thrombosis （DVT）. Methods The clinical data of 1455 cases of lower extremity DVT treated in January 1993 to November 2008 were analysed retrospectively. Antegrade infusion of high-dose urokinase was performed via the dorsalis pedis vein of the involved lower limb in1379 patients. Of the 1379 patients vena cava filters （VCF） was placed in 22 patients,including Tempofiher II VCF in 6patients, Vena Tech TM LPVCF in 16 patients. Other 76 cases underwent embolectomy after IVC filter placement （Tempofilter II was placed in 5patients,Vena Tech L P was placed in 61 patients）. Results After followed-up study for 3 months to 15 years, 98 IVC filters were successfully expanded,but 2 Tempofiher II VCF was migrated to proximal end of IVC. Tempofiher II VCF was taked out 2-4 week after the IVC filter placement. Vena TechTM LP occlusion in 8 cases 14 months after the IVC filter placement. In thrombolytic group,705 were cured, 648 improved, 26 ineffective. In operative group, 67 were cured, 7 improved, 2 ineffective. The cure rate in operative group was better than that in thrombolytic group （P〈0.05）,but the total effective rate was similar in both groups. Conclusion Vena cava filters placement can effectively prevent the form action of pulmonary embolism,but the indication should be strict.Combination of surgery with other therapy is effective in improving the results and preventing the sequela of lower extremity DVT.