腔静脉滤器置入联合胫后静脉置管溶栓治疗急性下肢深静脉血栓形成

Vena Cava Filter Placement combined with Posterior Tibial Vein Catheter Thrombolysis for Acute Deep Vein Thrombosis of the Lower Extremity

目的：探讨腔静脉滤器置入联合胫后静脉途径置管直接溶栓治疗急性下肢深静脉血栓形成的临床应用价值。方法：18例急性下肢深静脉血栓形成患者，先行患肢血管造影明确诊断后，在下腔静脉滤器置入的基础上采用胫后静脉置管微泵持续推注尿激酶直接溶栓治疗，对其中髂静脉狭窄5例和闭塞1例患者在拔除溶栓导管后实施髂静脉球囊扩张成形术。结果：18例患者置管溶栓治疗后症状均得到明显改善，1例术前合并肺动脉栓塞者症状消失。溶栓后的健、患侧大腿周径差及小腿周径差比治疗前明显减小，差异均有统计学意义（P〈0．001）。治疗期间，无一例围手术期死亡，无肺动脉栓塞发生，无置管处渗血或血肿形成、神经损伤等置管相关并发症发生。术后17例获随访，随访时间1～12个月，平均5个月。15例肢体肿胀基本消退、肌张力减低、恢复正常劳动力；2例活动后肢体出现轻微肿胀伴沉重感，能进行正常家务劳动；17例均未出现患肢浅静脉曲张及静脉营养性障碍。结论：腔静脉滤器置入联合胫后静脉置管直接溶栓治疗急性下肢深静脉血栓形成具有疗效好、创伤小、安全性高、适应证宽，便于护理等优点，是一种安全、有效的治疗方法。

Objective：To evaluate the clinical application value of the vena cava filter placement combined with posterior tibial vein catheter - directed thrombolysis in treatment of acute lower limb deep venous thrombosis （DVT）. Methods ： Results ：18 cases of patients with acute lower limb deep vein thrombosis, leading limb angiography diagnosis and on the basis of inferior vena cava filter placement underwent treatment by the posterior tibial vein catheter - directed thrombolysis with urokinase continues infusion immediately. 5 patients with iliac vein stenosis and 1 patient with iliac vein occlusion underwent treatment by iliac vein balloon expansion angioplasty after removing thrombolytic catheter. The symptoms of 18 patients were obviously improved after catheter- directed thrombolysis and symptoms of l cases with preoperative pulmonary embolism disappeared. After thrombolytic therapy, the health, affected thigh circumference and calf circumference was significantly re- duced than pre - treatment, the differences were statistically significant （ P 〈 0. 001 ）. No patients died after operation during treatment, there were no cases of pulmonary artery embolism, no patients had catheter site bleeding or hematoma formation and nerve injury or other complications. 17 cases were followed upl - 12 months, averageD 5 months. 15 cases of limb swelling disappeared, appeared hypotonia and recovered to nor- mal labor. 2 patients had slight swelling and heaviness of limb after activities, and could be engaged in normal household labor. In 17 cases there were no limb superficial varicose veins and venous nutrition disorder. Con- clusions ： The vena cava filter placement combined with posterior tibial vein catheter directed thrombolysis for acute lower limb deep venous thrombosis with good curative effect, less trauma, high safety, broad indications, convenient nursing and other advantages, is a safe, effective treatment method.