超声引导下置管溶栓治疗下肢深静脉血栓

Ultrasound-guided catheter-directed thrombolysis for deep venous thrombosis of lower extremity

目的探讨超声引导下经皮置管溶栓治疗下肢深静脉血栓形成(DVT)的临床应用价值。方法自2009年9月至2011年9月共收治下肢DVT患者34例,均采用下腔静脉滤器置入后,患肢在超声引导下经皮置管,持续导管内给予溶栓药物尿激酶50万u/d和肝素5 000 u/d,交替使用。其中2例患者合并下腔静脉血栓,采用经颈静脉途径释放下腔静脉滤器;2例患者采用大隐静脉置管;其余均采用经皮腘静脉置管。结果所有患者均置管成功,放置溶栓导管5～7 d。27例患者术后下肢肿胀基本消失,活动能力明显改善。5例患者活动后仍有较明显乏力和沉重感。1例患者术后3个月复发,再次置管后好转。1例患者术后6个月复发合并健侧下肢DVT,采用外周血管溶栓治疗。所有患者均采用DSA了解溶栓情况,26例患者髂股静脉术后连续性通畅,8例患者阶段性通畅。结论超声引导下经皮置管溶栓治疗具有创伤小、定位准确、药物剂量个人化以及溶栓率高等优点,是治疗DVT的有效方法。

Objective To assess the clinical value of ultrasound-guided percutaneous catheter-directed thrombolysis in treating lower extremity deep venous thrombosis （DVT）. Methods A total of 34 patients with DVT, admitted to our department during the period from September 2009 to September 2010, were enrolled in this study. After the inferior vena cave filter was implanted, ultrasound-guided percutaneous catheter-directed thrombolysis was carried out in all patients. Urokinase 500 000 U/d and heparin 5 000 U/d were administered continuously by using a micro-pump. Transjugular inferior vena cava filter placement was employed in 2 patients because of inferior vena cava thrombosis. Other 2 patients were treated with catheter- directed thrombolysis via the great saphenous vein. In the remaining patients ultrasound-guided insertion of thrombolysis catheter into popliteal vein was performed. The clinical results were analyzed. Results The thrombolysis catheter was successfully inserted in all patients, and the indwelling catheter remained in the vein for 5 to 7 days. After the treatment, the swelling basically disappeared and the daily activity was significantly improved in 27 patients. However, 5 patients still felt lacking in strength and leg heaviness after activity. One patient who relapsed 3 months after the surgery was treated by catheter-directed thrombolysis once more and got better. Another patient who relapsed 6 months after the surgery had deep venous thrombosis, which occurred in the contralateral lower extremity. Then the antic0agulation and thrombolysis through peripheral vein was applied. Angiography of the diseased lower extremity was performed in all the patients. Iliofemoral veins were unobstructed in 26 patients after the treatment, while in the other 8 patients the iliofemoral veins were unobstructed in segment. Conclusion Ultrasound-guided percutaneous catheterdirected thrombolysis has many advantages, such as minimal invasion, accurately positioning, individualization of drug dosage, high success rate of thrombolysis, etc. Therefore, this technique is an effective treatment for lower extremity DVT.