重组组织型纤溶酶原激活剂治疗妇科盆腔术后下肢深静脉血栓形成的临床研究

Clinical study on treating deep venous thrombosis of the low extremity by recombinant tissue type plasminogen activator after gynecological surgery

目的探讨妇科盆腔术后并发下肢深静脉血栓形成（DVT）早期应用溶栓的疗效及安全性。方法25例妇科盆腔术后并发早期下肢DVT患者随机分为抗凝治疗组（抗凝组13例）和溶栓治疗组[重组组织纤溶酶原激活剂（rt—PA）组12例]。抗凝组予低分子肝素0．4ml／d皮下注射，rt-PA组在此基础上一次性予rt．PA100mg经患肢静脉注射，7d观察静脉再通率、凝血酶原时间（胛）及出血等不良并发症。结果超声检查静脉rt—PA组复通率为91．7％（11／12），抗凝组为53．8％（7／13），2组差异有统计学意义（X^2=15．68，P〈0．01）；2组各有1例发生阴道残端出血，未发现其他器官部位出血，2组出血率差异无明显统计学意义（X^2=1．48，P〉0．05），2例阴道残端出血患者均经局部止血后未再出血。结论rt-PA用于妇科盆腔术后并发早期下肢DVT的治疗，能有效提高下肢DVT静脉复通率，且不良反应较低。

Objective To explore the clinical effect and safety of using recombinant tissue type plasminogen activator （rt-PA） in early lower extremity deep venous thrombosis （DVT） after gynecological surgeries. Methods Twenty-five cases with early DVT after gynecological operation were enrolled and randomly divided into two groups, contorl group （n = 13） and the rt-PA therapy group （n = 12）. The patients from contorl group were treated with Low-Molecular-Weight Heparins Calcium 0. 4 ml/d alone, and the rt-PA group accepted rt-PA 100 mg i. v in addition to the Low-Molecular-Weight Heparins Calcium. The recanalization rates of lamb veins, prothrombin time （PT）, bleeding event and other adverse complications were observed and evaluated at day seven. Results The recanalization rates of lamb veins were 91.7% （11/12） and 53.8 % （7/13） in rt- PA and the control group respectively,which showed significant difference between each other （ X2 = 15.68 ,P 〈 0. 01 ）. One case had vaginal stump bleeding in each group but no other hemorrhage in both group, the difference of bleeding rates between two groups didn＇t reach statistically significance （ X^2 = 1.48 ,P 〉 0. 05 ）. Two patients with vaginal stump bleeding were healed by local hemostasis. Conclusion The usage of rt-PA could improve the recanalization rate of DVT after gynecological surgery. The rates of adverse complications, including vaginal stump bleeding, were extremly low.