介入治疗巨块型肺动脉栓塞的疗效观察

Management of acute massive pulmonary thrombosis embolism with interventional techniques

目的对临床应用介入微创疗法治疗深静脉血栓及其并发症．巨块型肺动脉血栓的疗效和安全性进行探讨。方法对解放军总医院2000年10月至2010年3月收治的20例巨块型肺动脉栓塞患者，在经过下肢盆腔多普勒超声波检查、胸部增强CT以及血管造影确诊后，使用介入微创疗法对患者开展治疗，这20例患者部分是深静脉血栓（DVT）合并肺动脉血栓栓塞，且有8例为急性巨块型肺动脉栓塞。治疗期间，有11例次行经导管血栓抽吸、捣碎；有7例次行保留导管溶栓术；有11例次行下腔静脉过滤器置入术；有4例次行金属支架开通髂静脉阻塞术。所有患者在术后都给予低剂量溶栓和肝素治疗，在1周后改为长期口服抗凝剂治疗。术后随访6～24个月，患者复诊胸部x片、超声波以及增强CT。结果血栓抽吸、捣碎成功率100％，髂静脉支架置人术成功率100％，患者无重大并发症发生；巨块型肺动脉栓塞病情均累及患者的肺主干以及分支，患者动脉血压、氧饱和度均低于正常值，经过介入治疗后患者临床症状以及动脉血管造影主要结果均有明显改善。结论在治疗深静脉血栓及其并发症——巨块型肺动脉栓塞时介入方法有着重要的意义，可以较为安全、有效的对深静脉血栓及巨块型血栓进行治疗。

Objective To assess the efficacy and safety of interventional techniques in the treatment of deep venous thrombosis （DVT） and its complication of acute massive pulmonary thrombosis embolism （PTE）. Methods Twenty massive PTE patients received the examinations of Doppler ultrasonography, computed tomography （CT） and venography. After a definite diagnosis, interventional therapy was used for symptomatic controls. The interventional procedures included catheter fragmentation and suction （ n = 11 ）, catheter-directed thrombolysis （ n = 7 ） , stent placement （ n = 4 ） and inferior vena cava （ IVC ） filter placement （ n = 11 ）. After the above procedures, low doses of urokinase and heparin were prescribed for 1 week. During a follow-up period of 6 - 24 months, the findings of CT, radiography and ultrasound were reexamined. Results Interventions were successful. The success rates of fragmentation and suction and iliae vein stenting were both 100%. No major complications occurred. Pulmonary embolism involved main trunks and branches of lungs. Both arterial blood pressure and oxygen saturation were below normal values. After interventions, the clinical symptoms and angiographic results improved obviously. Conclusion It is safe and effective to apply catheter-directed mechanical fragmentation, suction and thrombolysis in the treatment of DVT and PTE. IVC filter may be useful for the prevention of PTE.