急性下肢深静脉血栓形成解剖分布与抗凝、溶栓及介入治疗的疗效比较

Acute deep venous thrombosis of lower extremity： anatomical distribution, comparison of anticoagulation, thrombolysis and interventional therapy

目的 根据急性下肢深静脉血栓形成（ DVT）的部位,比较单纯抗凝、足背静脉顺行溶栓及介入治疗3种方法的疗效.方法 回顾性分析204例急性下肢DVT患者的临床资料、静脉造影结果及治疗方法.根据血栓解剖部位将DVT分为3型：周围型、中央型和混合型.每型DVT根据治疗方法分为3组.A组（37例）单纯抗凝,B组（55例）足背静脉顺行溶栓,C组（112例）介入治疗.评价每型DVT患者住院期间选择不同治疗方法的效果.根据临床症状及造影复查计算各种治疗方法的优良率,其比较采用x2检验.结果 急性DVT发生于左下肢、右下肢、双下肢分别有132、62和10例,分别有4例（3.0％）、5例（8.1％）和2例合并肺栓塞（PE）,左、右、双下肢DVT合并PE的比率差异有统计学意义（x2=6.494,P=0.039）.周围型、中央型、混合型DVT分别有23、48和133例,分别有2（8.7％）、5（10.4％）和4例（3.0％）合并PE,三者发生PE的比率差异无统计学意义（x2=4.350,P=0.114）.23例周围型DVT中,A、B组分别为5和18例,治疗达到优良者分别为2和11例；48例中央型DVT中,A、B、C组分别为10、5和33例,治疗后达到优良的分别为1、2和26例,差异有统计学意义（x2= 16.157,P=0.000）；133例混合型DVT中,A、B、C组分别为22、32和79例,治疗后达到优良的分别为1、10和65例,差异有统计学意义（x2= 53.993,P=0.000）.结论 急性下肢DVT在左下肢患病率较右下肢高,且以混合型为主.3种方法中,中央型和混合型DVT介入治疗疗效最好,可根据血栓解剖分布类型指导治疗方案的选择.

Objective To investigate the anatomical distribution of acute deep venous thrombosis （DVT） of the lower extremity,and compare different therapeutic methods including anticoagulation alone,thrombolysis through dorsal vein and interventional therapy.Methods The clinical data,venography and therapies of 204 acute DVT patients were retrospectively studied According to the distribution,DVT were classified into three types including peripheral,central and mixed types.According to the difference of the therapeutic method,each type of DVT was divided into three groups,Group A （37 patients） anticoagulation alone：Group B（55 patients） thrombolysis through dorsal vein：and Group C（ 112 patients） interventional therapy.The results of different kind of treatment method in each type of DVT were evaluated before the patients were discharged and the Chi-square test was used for statistical analysis.Results There were 132 patients with DVT in the left lower extremity,62 in right lower extremity,and 10 in both extremities.The complication of pulmonary embolism （PE） occurred in 4,5 and 2 cases respectively,and the morbidity was 3.0%,8.1% and 20.0% （ x2 = 6.494,P = 0.039 ） respectively.There was significant statistical difference among them.There were 23 cases of peripheral type of DVT,48 central type and 133 mixed type.The complication of PE were observed in 2,5 and 4 cases respectively in each type.The morbidity was 8.7%,10.4% and 3.0% respectively （ x2 = 4.350,P = 0.114 ）.There were no statistical significance among them.In the 23 cases of peripheral type DVTs,2 of 5 in group A and 11 of 18 in group B had excellent therapeutic response.In the 48 cases of central type of DVTs,1 of 10 in group A,2 of 5 in in group B and 26 of 33 in group C had excellent therapeutic response.There were statistically significant differences among groups A,B and C （ x2 = 16.157,P =0.000）.In the 133 cases of mixed type DVTs,1 of 22 in group A,10 of 32 in group B and 65 of 79 in group C had excellent therapeutic response.There were statistically significant differences among group A,B and C （ 1,10,65 cases,x2 = 53.993,P =0.000）.Conclusions The incidence of acute DVT involving the left lower extremity was higher than that involving the right one,and the majority of cases was of the mixed type.The treatment of choice for the central and mixed types was interventional therapy.Analysis of anatomical distribution of deep venous thrombosis can guide treatment planning.