急性下肢深静脉血栓形成74例治疗分析

Analysis of 74 Cases with Acute Deep Venous Thrombosis in Lower Extremity

目的：观察下肢深静脉血栓形成（DVT）患者药物间接导向溶栓和手术取栓的疗效,为DVT的治疗提供参考依据.方法：下肢（DVT）患者共74例.发病＜7 d 45例中,手术治疗23例（手术组）,药物溶栓治疗22例（药物组1）;发病＞7d 29例（药物组2）均采用药物溶栓法治疗.手术组23例,采用Fogarty导管取栓;药物治疗51例采用尿激酶间接导向溶栓治疗.结果：手术取栓23例,15例发病时间＜3 d者,临床治愈率为93.3%,显效率为6.7%;另8例发病3～7 d者中,临床治愈率为50%,显效率为37.5%;不同发病时间疗效差异有统计学意义（P＜0.05）.药物溶栓组51例,临床治愈率为23.5%,显效率为41.2%,进步率为35.3%,不同发病时间之间疗效比较,差异有统计学意义（P＜0.05）.手术组与药物组1疗效比较,差异有统计学意义（P＜0.05）.药物组发生血栓形成后综合征35.3%（18/51）,手术组为21.7%（5/23）.结论：治疗时机和方法均会影响疗效,治疗时间较早疗效越好;发病7 d内手术取栓疗效优于药物溶栓.

Objective：To evaluate the therapeutic results of indirect targeting thromblysis with drugs and embolectomy for the deep vein thrombosis （DVT） in lower extremity, in order to provide evidence for the treatment of DVT. Methods ： 74 cases with DVT included 23 cases who accepted emboleetomy with Fogarty catheter and 51 cases received indirect targeting thrombolysis with urokinase. The 51 patients were consisted of 22 cases whose course of disease less than 7 days and other 29 more than 7 days. Results： In the embolectomy group, the clinical cure rate and effective rate were 93.3% and 6.7% in 15 cases whose course of disease less than 3 days, and 50% and 37.5% in other 8 cases whose course of disease from 3 to 7 days, respectively. Different course of disease influenced the curative effects （ P 〈 0.05 ）. In the thromblysis group, the cure, effective and improved rates were 23. 5%, 41.2% and 35.3%, respectively. There was statistically significant difference in curative effects along with va- rious courses of disease. Comparison of the embolectomy group with the thromblysis group whose course less than 7 days, there was significant difference in curative effects. The incidence rates of post-thrombogenesis syndrome were 35.3% （ 18/51 ）in the embolectomy group and 21.7% （5/23） in the thromblysis with drugs. Conclusions： The time and means of therapy could impact on the curative effectiveness of DVT which would be treated as early as possible. The embolectomy performed within 7 days of DVT could get better results than indirect targeting thromblysis with drugs.