下肢深静脉血栓手术与溶栓治疗效果的比较

Treatment for Deep Venous Thrombosis of Lower Extremities: Thromboectomy Versus Thrombolysis

目的评价手术与溶栓治疗下肢深静脉血栓的疗效。方法回顾性收集新疆医科大学两所附属医院住院的下肢深静脉血栓患者86例,根据治疗方式分为溶栓组与手术组,溶栓组74例,手术组12例。手术组运用Fogarty导管取栓加溶栓;溶栓组运用药物治疗(尿激酶或降纤酶)。结果出院时手术组治愈8例,好转4例,没有无效病例;溶栓组治愈15例,好转50例,无效9例。随访3～100个月,平均27个月。手术组瓣膜功能正常者6例,溶栓组有9例。手术组的急性期缓解率、远期通畅率、瓣膜功能正常率均明显高于溶栓组(P<0.05),且手术组血栓后综合征发生率明显低于溶栓组(P<0.05)。结论早期手术能够保持深静脉通畅及瓣膜的完整性,能够减少深静脉血栓后综合征,早期溶栓仅能减轻症状,但不能减少瓣膜的损害。

Objective To evaluate the treatment effective of deep vein thrombosis（DVT） of low extremities. Methods The clinical data of 86 patients with DVT were analyzed retrospectively,which were divided into thromboectomy group（12 patients） and thrombolysis group（74 patients） according to the therapy methods.The thromboectomy group patients were treated by thromboectomy using Fogarty balloon catheter plus thrombolytie,thrombolysis group patients were treated by thrombolysis（urokinase or anti-thrombus enzyme of viper）. Results There were 8 cases healed,4 cases relieved,0 invalidated in the thromboectomy group and 15 cases healed,50 cases relieved,9 cases invalidated in the thrombolysis group at discharge.During 3-100 months of following up with an average 27 months,10 cases and 62 cases were examined by B-ultrasonic in the thromboectomy group and thrombolysis group,respectively,6 cases were not damaged in the function of valves of the thromboectomy group,9 cases were not damaged in the function of valves of the thrombolysis group.The rates of acute response,long-time patency,and normal valve in the thromboectomy group were higher than those in the thrombolysis group（P〈0.05）,the rate of post-thrombotic syndrome in the thromboectomy group was lower than that in the thrombolysis group（P〈0.05）. Conclusions Early thromboectomy is an effective way of restoring the fluency of deep vein and protecting the efficiency of the vein value organization,and reducing the sequela of DVT.Thrombolysis can only relieve the symptomation,but it can not protect the crawling and relapsing of thrombus. 更多