导管接触溶栓治疗急性下肢深静脉血栓形成的临床问题分析

Catheter directed thrombolysis treatment of acute lower extremity deep venous thrombosis of the clinical problem analysis

目的 对导管接触溶栓（CDT）治疗急性下肢深静脉血栓形成中的临床问题进行讨论和分析.方法 回顾性分析2011年1月至2013年1月收治的182例急性下肢深静脉血栓形成进行CDT治疗患者的临床资料,讨论和分析其中的问题.结果 Ⅰ级（血栓清除率＞95％）93例（51.1％,93/182）,Ⅱ级（血栓清除率50％～95％）68例（37.4％,68/182）,Ⅲ级（血栓清除率＜50％）21例（11.5％,21/182）.其中61例合并髂静脉受压同时行髂静脉支架成形术;182例患者放置下腔静脉滤器22例,未放置的患者中发生肺栓塞1例;全部病例随访10个月,其中148例（81.3％,148/182）获得了深静脉再通.结论 CDT溶栓治疗下肢急性深静脉血栓形成疗效显著,并能提高深静脉通畅率减少深静脉血栓后遗症的发生率,是值得临床推广的方法,但应用中要注意入路、滤器的放置、髂静脉受压处理的问题.

Objective To discuss and analyze the issue in the catheter directed thrombolysis（CDT） treatment of acute lower extremity deep venous thrombosis.Methods The clinical data of 182 cases of acute lower extremity deep venous thrombosis from January 2011 to January 2013 which were treated by CDT were retrospectively analyzed,and the issues in these treatment were discussed and analyzed.Results The effect were classified into three degrees.Thrombosis clearance exceed 95 percent belonged to the first degree,among 50 percent and 95 percent belonged to the second degree,and below 50 percent belonged to the third degree.In this study,the respective number of each degree were 93/68/21.Sixty-one cases combined iliac venous compression syndrome were treated by stent.Twenty-two cases were treated with inferior vena cava filter.All the patients were followed up 10 months,148 cases of them maintained patency.Conclusions The effect of CDT treatment to acute lower extremity deep venous thrombosis is remarkable,meanwhile the patency is improved and the deep vein thrombosis were decreased through this method.But the issues of access,filter and iliac venous compression syndrome should also be considered.