导管溶栓术治疗急性下肢深静脉血栓形成的早中期疗效

Early and midterm outcomes of acute lower extremity deep venous thrombosis treated by catheter directed thrombolysis

目的观察导管溶栓术(CDT)治疗急性下肢深静脉血栓形成(DVT)的早中期疗效。方法 33例急性下肢DVT患者接受CDT治疗,以静脉通畅改善度以及大腿和小腿健、患侧肢体周径差值(患肢周径-健肢周径)评估CDT术后早期疗效,以正常股浅静脉第一对瓣膜比例和下肢慢性静脉功能不全症状评分(VCSS)评估CDT术后中期疗效。结果 CDT手术技术成功率100%,发生出血并发症5例,平均CDT治疗时间(3.93±1.14)d。术后平均静脉通畅改善度(69.25±18.93)%,大腿和小腿健、患侧肢体周径差值显著小于术前(P<0.01,P<0.05)。成功随访29例,随访时间6～27个月。术后3个月和6个月,血栓溶解Ⅱ级和Ⅲ级患者正常股浅静脉第一对瓣膜比例显著高于Ⅰ级患者(P<0.05,P<0.01),VCSS显著低于Ⅰ级患者(P<0.01)。结论CDT治疗急性下肢DVT早中期疗效较好,严重并发症较少。

Objective To investigate the early and midterm outcomes of acute lower extremity deep venous thrombosis（DVT） treated by catheter directed thrombolysis（CDT）. MethodsThirty-three patients with DVT underwent CDT treatment.The early outcome after CDT treatment was assessed by the rate of patency improvement and differences in circumference between impaired thigh and healthy thigh and between impaired leg and healthy leg after CDT treatment,and the midterm outcome was evaluated with percents of normal first valve in superficial femoral vein and venous clinical severity score（VCSS）. ResultsThe initial technical success rate of CDT treatment was 100%,with 5 cases of minor bleeding complications.The mean duration of CDT treatment was（3.93±1.14） d.The mean rate of patency improvement after treatment was（69.25±18.93）%.The differences in circumference between impaired thigh and healthy thigh and between impaired leg and healthy leg after treatment were significantly smaller than those before treatment（P0.01,P0.05）.Twenty-nine patients were successfully followed up for 6 to 27 months.Three months and 6 months after treatment,the percents of normal first valve in superficial femoral vein in patients with thrombolysis grade Ⅱ and Ⅲ were significantly higher than that in patients with thrombolysis grade Ⅰ（P0.05,P0.01）,and VCSS in patients with thrombolysis grade Ⅱ and Ⅲ were significantly lower than that in patients with thrombolysis grade Ⅰ（P0.01）. ConclusionFavorable early and midterm outcomes with less severe complications may be yielded in patients with acute lower extremity DVT treated by CDT.