经小隐静脉导管直接溶栓治疗急性混合型下肢深静脉血栓形成

TRANSCATHETER THROMBOLYSIS VIA THE SMALL SAPHENOUS VEIN FOR ACUTE LOWER LIMB DEEP VENOUS THROMBOSIS

目的探讨经小隐静脉途径置管直接溶栓治疗急性混合型下肢深静脉血栓形成的临床应用价值。方法分析2008年9月—2011年12月收治的41例急性混合型下肢深静脉血栓形成患者的资料,于数字减影血管造影下溶栓导管插入静脉血栓,微泵持续灌注尿激酶(149.1±38.3)万U直接溶栓。以静脉通畅评分和静脉通畅率评价疗效。结果全部患者溶栓后症状明显改善,35例患者治疗后静脉造影复查显示,静脉通畅评分差异有统计学意义(t=13.926,P<0.01),静脉通畅率改善(50±22)%,治疗过程中未出现严重并发症。33例患者得到随访,随访率80.0%,随访时间6～27个月,平均(15.5±6.0)个月。随访满6个月时测患者双下肢周径,差距进一步缩小。结论经小隐静脉置管直接溶栓治疗急性混合型下肢深静脉血栓形成,是一种疗效良好而且安全的治疗方法 。

Objective To evaluate transcatheter thrombolysis via the small saphenous vein in the treatment for lower limb acute mix-deep venous thrombosis （DVT）. Methods From Sep. 2008 to Dec. 2011,41 patients with lower limb acute mix-DVT underwent catheter-directed thrombolysis via the small saphenous vein with urokinase （ 149.1± 38.3 ） x 104U continuous infusion. The venous patency score and the rate of patency improvement were observed by venograms before and after therapy. Results Symtoms were significantly alleviated in all patients after the transcatheter thrombolysis. Venous patency score were significantly improved （t = 13. 926,P 〈0.01 ）. The mean rate of venous patency was （50 ± 22） %, and there was no severe complication. Thirty-three patients （ 80. 0% ） were followed up for （ 15.5 ± 6.0 ） months. The cross section diameter of the lower limbs was significantly reduced after 6 monthes. Conclusion This preliminary experience suggests that catheter-directed thrombolysis via the small saphenous vein with urokinase for acute lower limb mix-DVT is safe and effective.