介入导管溶栓治疗急性下肢深静脉血栓形成32例

Catheter-directed thrombolysis for patients with acute deep venous thrombosis of the lower limb： report of 32 cases

目的 探讨经腘静脉置入溶栓导管持续灌注溶栓药物治疗急性下肢深静脉血栓形成（deep venous thrombosis,DVT）的临床应用价值.方法 本组32例急性DVT患者（其中3例合并肺动脉栓塞）,男15例,女17例,年龄18 ～71岁,平均（51±17）岁.在超声引导下经患肢腘静脉穿刺置入溶栓导管至髂、股静脉血栓中进行溶栓治疗,并对溶栓效果进行分析.结果 全组患者溶栓后症状明显改善,下肢肿胀消退,肺部症状缓解.溶栓后患、健侧大腿周径差为（1.7±1.3）cm,明显小于溶栓前（5.4±1.4）cm,两者相比差异有统计学意义（t=9.92,P＜0.01）.患肢大腿消肿率为91.74％；溶栓后患、健侧小腿周径差为（1.5±0.7）cm,明显小于溶栓前（4.1±1.5）cm（t =7.65,P＜0.01）.患肢小腿消肿率为86.02％.溶栓前静脉通畅评分（15±4）分,明显高于溶栓后（4±3）分（t=7.12,P＜0.01）,溶栓后静脉平均通畅率为88.21％.3例合并肺动脉栓塞患者1例栓子完全溶解,2例大部分溶解.所有患者均无严重并发症.29例患者获随访,随访3 ～ 12个月,平均（7.8±2.4）个月.无一例出现血栓再发.结论 经腘静脉置管溶栓治疗急性DVT是一种安全、有效的治疗方法.

Objective To evaluate catheter-directed thrombolysis via the popliteal vein in the treatment of the lower limb acute deep venous thrombosis.Methods From July 2009 to October 2010,32patients of the lower limb acute deep venous thrombosis including 3 patients with concurrent pulmonary embolism underwent uhrasound-guided catheter-directed thrombolysis via the popliteal vein.The thrombolytic catheter was inserted into thrombus,through which urokinase was infused at a dosage of 100 × 104U/d.The venous patency score and the rate of patency improvement were observed by venograms before and after therapy.Results In every patient,the lower limb swell and pulomonary symptoms relieved.The circumferences between affected and normal thigh before and after the thrombolysis were（5.4 ± 1.4）cm and （1.7 ± 1.3）cm（t =9.92,P 〈0.01）.The circumferences between affected and normal leg before and after the thrombolysis were（4.1 ± 1.5）cm and（1.5 ±0.7）cm（t =7.65,P 〈0.01）.The venous patency score before and after the thrombolysis were（15 ± 4）and（4 ± 3）（t =7.12,P 〈 0.01）.The mean rate of venous patency was 88.21%.In the 3 patients with pulmonary embolism,thrombus was complete dissolved in 1 case and partial dissolved in 2 cases.No major complications occurred in all these patients.29 patients were followed up for 3-12 months.There were no thrombosis relapsed.Conclusions Catheter-directed thrombolysis via the popliteal vein with urokinase for acute lower limb deep venous thrombosis is safe and effective.