急性下肢深静脉血栓形成导管直接溶栓疗效分析

Catheter-directed thrombolysis for acute lower limb deep venous thrombosis

目的评价导管直接溶栓治疗急性下肢深静脉血栓形成的临床疗效。方法 2004年8月至2009年10月,上海交通大学医学院附属仁济医院血管外科对217例急性下肢深静脉血栓形成病人,于数字减影血管造影（DSA）下溶栓导管直接插入静脉血栓,微泵持续灌注尿激酶（261.26±95.35）万单位溶栓。以静脉通畅评分和静脉通畅率评价疗效,治疗半年以上随访。结果 194例病人治疗后静脉造影复查显示,静脉通畅评分显著改善（P〈0.01）,静脉通畅率（62.24±15.47）%。治疗过程中未出现严重并发症。153例病人取得大于半年随访（随访率70.51%）,随访时间6~28（13.75±7.63）个月。静脉造影显示,静脉通畅评分显著改善（P〈0.01）,静脉通畅率为（68.37±17.54）%。126例深静脉瓣膜得以保存,深静脉瓣膜保存率达82.35%。结论导管直接溶栓治疗急性下肢深静脉血栓形成,是一种疗效良好而且安全的治疗方法。

Objective To evaluate the efficacy of catheter-directed thrombolysis in treatment of acute lower limb deep venous thrombosis（DVT）.Method 217 patients with lower limb acute DVT underwent treatment by cathter-directed thrombolysis with urokinase（261.26±95.35）×104IU continues infusion immediately.The venous patency score and the rate of patency were measured before and after lysis,improvement were observed by venograms.some patients were followed.Results After lysis,the venous patency score was significant difference（P0.01）.The mean rate of venous patency improvent was（62.24±15.47）%.153 patients were followed 6～28 monthes,average（13.75±7.63）monthes.The mean score of venous patency was also significant difference（P0.01）,the mean rate of venous patency improve to（68.37±17.54）%.The valve function preserved in 126 patients（82.35%）.Conclusion This initial experience suggest that catheter-directed thrombolysis with urokinase for treatment of acute lower limb DVT is safe and effective.