导管取栓及导管接触性溶栓在急性下肢深静脉血栓中的临床应用

The clinical application of catheter thrombectomy and catheter-directed thrombolysis in acute lower limb deep vein thrombosis

目的观察导管取栓及导管接触性溶栓治疗急性下肢深静脉血栓形成(DVT)的临床效果。方法2007年6月—2008年11月,对急性下肢DVT患者56例于DSA下行下腔静脉滤器植入术后,应用10F导管取栓,取栓后将5F直头多侧孔导管置于下肢深静脉血栓内,应用微量推注泵经导管持续泵入尿激酶,每小时5万U左右,行溶栓治疗。21例患者于取栓后溶栓治疗之前行单纯球囊扩张治疗,6例患者于溶栓后行髂总静脉及髂外静脉支架植入术治疗,以静脉通畅评分和静脉通畅率及健、患肢周径差等指标评价疗效,患者随访6个月以上。结果56例患者于治疗3个月左右复诊,患侧大腿、小腿周径差均低于治疗前(P<0.01);行下肢静脉造影复查,静脉通畅评分显著改善(P<0.01),静脉通畅率为(65.2±14.6)%。治疗过程中未出现严重并发症。结论导管取栓及导管接触性溶栓治疗急性下肢深静脉血栓是一种安全有效的治疗方法。

Objective To assess the clinical effect of catheter thrombectomy and catheter-directed thrombolysis in acute lower limb deep vein thrombosis （DVT） Methods Consecutive 56 acute lower limb DVT patients, from July,2006 to Nov ,2008 ,were enrolled. All patients underwent permanent inferior vena cava filter and recyclable type of inferior vena cava filter or temporary type of inferior vena cava filter implantation. Then applying 10F catheter to get thrombus,putting 5F head straight multi-side holes catheter into deep vein thrombus of lower limb,and micro-injection pump to pump urokinase constantly, in the speed of around 50 000 U in order to thrombolysis. 21 patients were implemented treatment of simple balloon dilatation during the period between thrombectomy and thrombolysis. Meanwhile 6 patients were treated with common iliac vein and external iliac vein stent implantation. After more than 6months followed up, the rating in light of vein patency and appraising by difference of circumference of health and ill limb were evaluated. Results The vein patency grading was improved significantly （ P 〈 0.01 ） and vein patency rate was （65.2±14.6）% ,when all the 56 patients received lower limb venography review 3months after treatment,and there was no serious complications during the process. Conclusion The catheter thrombectomy and catheter-directed thrombolysis was proved to be safety and effective to acute lower limb DVT.