下肢深静脉血栓形成的血管腔内治疗

Endovascular therapy for lower extremity deep venous thrombosis

目的探讨腔内治疗下肢深静脉血栓形成(LEDVT)的临床效果。方法回顾性分析2000年1月至2010年12月收治的1068例LEDVT患者临床资料,其中中央型311例,混合型549例,周围型208例。足背静脉、股静脉穿刺造影,下腔静脉滤器植入,进行机械性血栓抽吸,取栓后造影髂静脉存在严重狭窄(>50%)或闭塞时则球囊扩张和支架植入,残留血栓术后辅助溶栓治疗。随访评估患者腔内治疗的近期、中期疗效。结果近期疗效Ⅰ级65.45%,Ⅱ级25.75%,Ⅲ级8.05%,Ⅳ级0.75%;总有效率99.25%,不同分型的疗效差异均有统计学意义(P<0.05)。术后2年随访,优76.06%,良16.41%,中6.28%,差1.25%;支架通畅率88.62%。结论 LEDVT腔内治疗,能尽早清除深静脉主干血栓,迅速恢复血流,缩短病程,近、中期疗效显著。

Objective To investigate the clinical effect of endovascular therapy for acute lower extremity deep venous thromhosis（LEDVT）. Methods The clinical data of 1068 patients treated from January 2000 to December 2010 were analysed retrospectively. There were 311 cases of central type, 549 mixed type and 208 calf DVT. Foot dorsal vein and femoral vein were punctured to obtain venogram respectively. An Inferior vena cava filter was prophylactic placed. Then mechanical aspiration thrombectomy was performed via ipsilateral vein; patients with stenosis（ 〉 50 % ） or obstruction of iliac vein underwent venoplasty and stent placement. Residual thrombus underwent thrombolytic treatment postoperatively. Patients received endovascular therapy were given a short-term and medium-term follow-up evaluation. Results The rate of thrombus removal was Grade Ⅰ 65.45%, Grade Ⅱ 25.75%, Grade Ⅲ 8.05%, Grade Ⅳ 0.75%, respectively. Total effective rate was 99.25%. Postprocedure 24 months follow-up, ＂Excellent＂ 76.06%, ＂Moderate＂ 16.41%, ＂Mild＂ 6.28%, ＂Poor＂ 1.25%. The stent patency rate was 88.62%. Conclusion Endovascular therapy for acute LEDVT, which can remove thrombus as soon as possible, restore the blood flow instantly, and shorten hospitalization, has a notable short- and medium-term clinical effect.