猪尾巴导管碎栓联合灌注溶栓治疗Cockett综合征合并急性左下肢中央型深静脉血栓

Pigtail catheter mashing thrombosis combined with catheter directed thrombolysis in the treatment of acute iliofemoral venous thrombosis in patients of Cockett syndrome

目的探讨猪尾巴导管碎栓联合灌注溶栓在治疗Cockett综合征合并急性左下肢中央型深静脉血栓中的临床应用价值。方法回顾性分析福建医科大学附属协和医院在2007年1月至2012年10月采用介入方法治疗急性下肢深静脉中央型血栓形成137例患者的临床资料。所有患者均行下腔静脉可回收滤器置入，其中采用单纯灌注溶栓术（溶栓组）81例，猪尾巴导管碎栓联合灌注溶栓（碎栓组）56例，2组临床资料差异无统计学意义（P〉0．05），具有可比性。术后均局部应用尿激酶溶栓、低分子肝素钙抗凝治疗。后期应用华法林抗凝6—12个月。结果2组共133例患者完成溶栓及碎栓疗程，治疗后症状均明显改善，碎栓组较溶栓组溶栓时间更短（P〈0．01），尿激酶用量更少（P〈0．01），碎栓组在治疗后的1、3、5d静脉通畅度评分显著优于溶栓组（P〈0．01），治疗后碎栓组静脉通畅度评分优于溶栓组（P〈0．01），总体静脉通畅率亦明显优于溶栓组（P〈0．01）。121例患者（溶栓组70例，碎栓组51例）得到随访，随访率88．32％，失访16例（溶栓组11例，碎栓组5例）。随访时间随访时间10～60个月，2组均未发生肺动脉栓塞。结论猪尾巴导管碎栓联合灌注溶栓治疗下肢深静脉血栓可提高溶栓效率，缩短溶栓时间，减少尿激酶用量。

Objective To evaluate pigtail catheter mashing thrombosis combined with catheter directed thrombolysis in the treatment of acute iliofemoral venous thrombosis complicated by Cockett syndrome in the left lower limbs. Method Data of 137 cases of acute iliofemoral venous thrombosis complicated with Cockett syndrome in left lower limb by interventional therapy from January 2007 to October 2012 were analyzed retrospectively. Inferior vena cava filters were placed in all of the patients. Patients were divided into two groups ： Group A （ n = 81 ） treated with catheter directed thrombolysis only, Group B （ n = 56） treated with pigtail catheter mashing thrombosis combined with catheter directed thrombolysis. After operation, patients were treated by anticoagulation with urokinase and heparin calcium, and then warfarin for 6 to 1 2 months. Results The thrombolysis time in group B was significantly shorter than that in group A （ P 〈 0. 01 ） , the dosage of urokinase was significantly less than that in group A （ P 〈 0. O1 ）. The venous patency score in group B after therapy was significantly better than in group A （ P 〈 0. O1 ）. 121 patients were followed up for 10 - 60 months. There were no pulmonary embolism. Conclusions Pigtail catheter mashing thrombosis combined with catheter directed thrombolysis in the treatment of acute iliofemoral venous thrombosis complicated with Cockett syndrome in left lower limb can improve thrombolytic efficiency, shorten thrombolysis time, reduce the use of urokinase.