介入治疗急性深静脉血栓的临床观察

Interventional therapy for acute deep venous thrombosis:a clinical observation

目的比较导管介入直接溶栓和系统性溶栓治疗急性深静脉血栓(DVT)的疗效。方法自2008年8月-2010年8月采用导管介入直接溶栓和系统溶栓治疗44例DVT患者,患者平均年龄(42.3±8.7)岁,其中23例接受导管直接溶栓治疗,21例接受系统溶栓治疗。所有病例患DVT的平均时间为(5.9±4.5)d。通过外周静脉或介入导管输注尿激酶进行治疗。溶栓后残留静脉狭窄用经皮球囊血管成形和(或)支架置入治疗。结果导管直接溶栓组中20例(86.9%)栓塞静脉段复通,3例(13.0%)行PTA治疗,残留狭窄以支架成形治疗。系统溶栓组21例中,4例(20%)栓塞静脉段复通,1例并发肺栓塞死亡。结论在治疗急性DVT中,导管直接溶栓法疗效优于系统溶栓法。

Objective To compare the clinical efficacy of catheter-directed thrombolytic therapy with that of systemic thrombolytic therapy in treating acute deep venous thrombosis（DVT）.Methods During the period from August 2008 to August 2010,a total of 44 patients with DVT were encountered in the hospital.The mean age of the patients was（42.3 ± 8.7） years.Of the 44 patients,catheter-directed thrombolytic therapy was performed in 23 and systemic thrombolytic therapy was employed in 21.The mean interval between the onset of DVT to the start of treatment was（5.9 ± 4.5） days.Infusion of urokinase through catheter or peripheral veins was carried out.For the residual venous narrowing after thrombolytic therapy percutaneous balloon dilation angioplasty and/or stent placement was employed.Results Of the 23 patients receiving catheter-directed thrombolytic therapy,reopen of the obstructed vein was obtained in 20（86.9%） and percutaneous balloon dilation angioplasty had to be carried out in 3（13.0%）.Of the 21 cases receiving systemic thrombolytic therapy,reopen of the obstructed vein was seen in 4（20%） and death due to pulmonary embolism occurred in one.Conclusion For the treatment of acute deep venous thrombosis the catheter-directed thrombolytic therapy is better than the systemic thrombolytic therapy.