经导管接触溶栓与单纯静脉药物溶栓治疗下肢深静脉血栓的对比分析

Comparative Analysis Approach for Transcatheter Directed Thrombolysis and Trans-Dorasalis Pedis Vein Thrombolysis in Treatment for Deep Venous Thrombosis of Lower Limbs

目的探讨经导管接触溶栓治疗下肢深静脉血栓形成(DVT)的临床疗效,并与单纯静脉溶栓治疗的疗效进行比较。方法收集我院2008年7月至2012年1月期间共437例急性下肢DVT患者,男184例,女253例;年龄(43±12)岁(19～76岁);左侧355例,右侧54例,双侧28例;混合型211例,中央型147例,外周型79例。对其中358例中央型及混合型DVT患者的临床资料进行回顾性分析总结,其中行经导管接触溶栓治疗(经导管接触溶栓组)293例,置管前植入下腔静脉滤器32例;单纯静脉溶栓治疗(单纯静脉溶栓组)65例,植入下腔静脉滤器4例。以治疗前后患肢周径差、溶栓并发症、远期通畅率及瓣膜功能情况为指标评价疗效。结果经导管接触溶栓组治疗前、后大腿和小腿的周径差分别为(7.02±2.17)cm和(4.59±2.85)cm,单纯静脉溶栓组分别为(6.34±2.09)cm和(3.87±2.82)cm,经导管接触溶栓组大腿和小腿的周径差均明显大于单纯静脉溶栓组(P<0.05)。随访(26±6)个月(6～48个月)。经导管接触溶栓组出现穿刺处血肿3例,滤器移位1例,牙龈出血或肉眼血尿4例;单纯静脉溶栓组牙龈出血或肉眼血尿5例。经导管接触溶栓组深静脉瓣膜保存率为(78.2±12.6)%,明显低于单纯静脉溶栓组的(91.1±10.7)%,2组间比较差异有统计学意义(P<0.05);经导管接触溶栓组的远期静脉通畅率为(65.2±15.4)%,单纯静脉溶栓组为(63.8±16.3)%,2组间比较差异无统计学意义(P>0.05)。结论经导管接触溶栓及外周静脉溶栓均能有效减轻症状,经导管接触溶栓可以缩短病程时间,但增加深静脉瓣膜损伤。

Objective To investigate the feasibility and efficacy of transcatheter directed thrombolysis（TDT） approach in treatment for deep venous thrombosis（DVT）of lower limbs and as compared with trans-dorsal pedis vein thrombolysis（TPVT）approach.Methods The clinical data of 437 patients with acute DVT（184 males and 253 females）at the age of（43±12）years（range 19-76 years）from July 2008 to January 2012 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Patients in the group TDT received TDT were 293 cases,32 inferior vena cava filters were implanted.Patients in the group TPVT received TPVT were 65 cases,4 inferior vena cava filters were implanted.Results The resolution time of thrombus in the group TDT was shorter than that in the group TPVT（6 d versus 9 d,P0.05）.The circumference difference of leg or upper leg before and after treatment in the TDT group was significantly greater than that in the TPVT group（P0.05）.The rate of venous patency was（65.2±15.4）% and preservation rate of valvular function was（78.2±12.6）% in the group TDT,and which was（63.8±16.3）% and（91.1±10.7）% in the group TPVT,respectively.The differences of venous patency rate was not statistically significant（P0.05）between two groups,but the prevervation rate of valvular function was significant difference（P0.05）.Hematomas in 3 cases and gross hematuria in 4 cases were observed,and displacement of inferior vena cava filter occurred in 1 patient in the group TDT.The gums bleed or gross hematuria in 5 cases were observed in the group TPVT.Conclusions Both TDT and TPVT can effectively relieve symptoms.TDT can shorten the course of disease,but it increases functional damage of the deep vein valvular.