经患侧大隐静脉入路置管溶栓治疗急性髂股静脉血栓的临床对比研究

Catheter-directed thrombolysis for acute iliofemoral deep saphenous vein approach： a comparative clinical study vein thrombosis via the ipsilateral great

目的 研究经患侧大隐静脉穿刺入路置管溶栓治疗急性髂股静脉血栓的可行性及临床应用价值.方法 93例经造影明确诊断的急性髂股静脉血栓患者,按照简单随机化方法分为3组,A组经患侧大隐静脉入路置管溶栓（31例）,B组经患侧腘静脉入路置管溶栓（27例）,C组经足背静脉顺性溶栓（35例）.根据临床症状和溶栓后第5天造影复查结果评估疗效.对3组治疗前后消肿率、静脉通畅度采用方差分析（LSD法）进行组间比较；置管组穿刺时间、舒适度评分采用成组t检验分析；3组疗效及并发症发生情况采用x2检验分析.结果 治疗有效率A组90.3％ （28/31）、B组92.6％ （25/27）、C组68.6％ （24/35）,A组与B组相比差异无统计学意义（x2=0.09,P=0.759）,A组与C组相比差异有统计学意义（x2 =4.65,P=0.031）;消肿率A组（83.5±21.1）％、B组（82.4±20.1）％、C组（67.0±23.3）％,3组之间差异有统计学意义（F=6.059,P=0.003）,A组与B组相比,差异无统计学意义（P =0.822）、A组与C组相比,差异有统计学意义（P=0.002）；静脉通畅度A组（61.2±20.2）％、B组（55.7±20.5）％、C组（44.2±23.6）％,3组之间差异有统计学意义（F=5.342,P=0.006）,A组与B组相比差异无统计学意义（P =0.343）,A组与C组相比差异有统计学意义（P=0.002）.穿刺时间A组为（8.3±3.1） min,较B组的（16.3±3.5） min少（t=9.379,P＜0.05）；治疗期间患者舒适度评分A组为（2.2±1.2）分、B组为（5.0±1.4）分,差异有统计学意义（t =8.129,P＜0.05）；置管相关的并发症A组（3例）少于B组（11例）,差异有统计学意义（x2=7.60,P＜0.05）.结论 经患侧大隐静脉入路置管溶栓治疗急性IFVT是可行、有效的方法,具有操作简便、并发症少的优点.

Objective To investigate prospectively the feasibility and clinical value of catheterization via the ipsilateral great saphenous vein in catheter-directed thrombolysis （CDT） for acute iliofemoral deep vein thrombosis （IFVT） by a comparative study.Methods The prospective study included 93 cases of IFVT proved by venography.All patients were divided into three groups randomly.In group A,31 patients received CDT via the ipsilateral great saphenous vein.In group B,27 patients received CDT via the ipsilateral popliteal vein.In group C,35 patients received anterograde thrombolysis via an ipsilateral dorsalis pedis vein.Urokinase was adopted as the thrombolytic agent in all cases.The assessment of the curative effect include therapeutic effective rate,rate of edema reduction and venous patency which were observed according to the clinical symptoms and the follow-up venograms obtained 5 days after thrombolysis.The time and comfort scores of procedures was recorded and compared between group A and B using two independent samples t test.The rate of edema reduction and venous patency were assessed using analysis of variance （LSD method）.Therapeutic effective rate and complication rate were assessed using Chi-square test.Results The total effective rate of the three groups were 90.3% （28/31）,92.6% （25/27） and 68.6% （24/35） respectively.The limbs edema reduction rate were （83.5 ±21.1）%,（82.4 ±20.1）%,and（67.0±23.3）% respectively（F=6.059,P = 0.003 ）.The venous patency rate after thrombolysis were （61.2 ± 20.2） %,（55.7 ± 20.5 ） %,and （44.2 ±23.6）% respectively.There was no significant difference between group A and B in therapeutic effective rate（ x2 =0.09,P =0.759）,rate of edema reduction（ P =0.822 ） and venous patency （ P =0.343 ）.There was a significant difference statistically in therapeutic effective rate（x2 =4.65,P =0.031 ）,rate of edema reduction （P = 0.002） and venous patency （P = 0.002） between group A and C.Compared with group A and B,the procedure time [group A （8.3 ±3.1） min,group B （16.3 ±3.5） min,t =9.379,P 〈0.05],comfort scores during treatment [ group A （2.2 ± 1.2）,group B （5.0 ± 1.4 ）,t = 8.129,P 〈 0.05 ] had statistical significant difference.The CDT-asscciated complications in group A were less than group B significantly（3 cases in group A,11 cases in group B,x2 =7.60 P 〈0.05）.Conclusions Catheterizationvia the great saphenous vein in CDT therapy for acute IFVT is feasible and effective.It is easily operable with less complications.