系统抗凝、置管溶栓与血栓切除治疗急性髂股段静脉血栓形成的疗效Meta分析

The clinical efficacy of catheter directed thrombolysis,thrombectomy and systematic anticoagulant in acute iliofemoral deep vein thrombosis:A Meta analysis

目的：应用Meta分析研究系统抗凝（SA）、置管溶栓（CDT）与血栓切除（ST）治疗急性髂股段血栓形成（AIFDVT）的疗效。方法以“髂股静脉，抗凝，置管溶栓，血栓切除术，随机对照研究”为关键词检索Pubmed、M edline、Elsevier等数据库1984年1月至2014年1月发表的关于SA、ST、CDT临床效果的随机对照研究（RCT），应用Meta分析评价早期血管再通率、深静脉血栓后遗症（PTS）发生率、血管反流（VR）率、管腔堵塞（VO）率等相关指标。结果有10篇随机对照研究纳入此分析，包括626例患者。早期血管再通率：CDT组高于SA组，差异有统计学意义（OR＝4．61，95％ CI：1．93～10．98，P＜0．05）；ST组与SA组比较差异无统计学意义（OR＝2．54，95％ CI：0．49～13．24，P＞0．05）；术后 PTS发生率：CDT 组低于SA组（OR＝0．18，95％ CI：0．07～0．43，P＜0．05），ST组低于SA组（OR＝0．50，95％ CI：0．28～0．87，P＜0．05）；术后 VR发生率：CDT 组与SA组比较（OR＝0．54，95％ CI：0．29～1．01）、ST组与SA组比较（OR＝0．54，95％ CI：0．27～1．08），差异均无统计学意义（P＞0．05）；术后VO发生率：CDT组低于SA组，差异有统计学意义（OR＝0．19，95％ CI：0．11～0．34，P＜0．05），ST 组与SA组比较差异无统计学意义（OR＝1．53，95％ CI：0．72～3．26，P＞0．05）。结论 CDT治疗AIFDVT的早期疗效明显优于传统SA。关于远期疗效， ST、CDT较传统SA均能有效降低PTS发生率，且CDT还能降低血管栓塞的发生率。

Objective To compare the clinical efficacy of catheter directed thrombolysis（CDT ） ,thrombectomy（ST ） and system‐atic anticoagulant（SA） in treating acute iliofemoral deep vein thrombosis（AIFDVT ） of lower limb using Meta analysis method . Methods The systematic review was initialted by electronic literature searches （PUBMED ,MEDLINE ,ELSEVIER ,etc .） for stud‐ies comparing catheter directed thrombolysis ,thrombectomy and systematic anticoagulant clinical effects published from January 1984 to January 2014 based on the keyword such as ＂iliofemoral deep vein thrombosis;thrombolysis;anticoagulant therapy ;throm‐bectomy ;RCTs;Meta analysis＂.A Meta analysis was conducted to estimate early vein patency ,post thrombotic syndrome（PTS） , venous reflux（VR） rate ,venous obstruction（VO） rate ,etc .Results Ten RCTs were included in this analysis ,including 626 pa‐tients .The early vein patency rate was higher in the CDT group and the difference was statistically significant（OR=4 .61 ,95% CI 1 .93-10 .98 ,P〈0 .05）;there was no statistically difference between ST and SA group（OR= 2 .54 ,95% CI 0 .49 -13 .24 ,P〉0 .05） .The post thrombotic syndrome rate was less both in the CDT group（OR=0 .18 ,95% CI 0 .07 -0 .43 ,P〈 0 .05） and ST group（OR=0 .50 ,95% CI 0 .28 -0 .87 ,P〈 0 .05）;the difference was statistically significant .The difference of the venous reflux rate was not statistically significant in both two groups .The venous obstruction rate was less in the CDT group（OR=0 .19 ,95% CI 0 .11-0 .34 ,P〈0 .05） and the difference was statistically significant ;while the difference was not statistically significant between ST and SA group （OR=1 .53 ,95% CI 0 .72-3 .26 ,P〉0 .05） .Conclusion For acute iliofemoral deep vein thrombosis（AIFDVT） , short term （〈 7 d） outcomes of catheter directed thrombolysis was better than anticoagulant therapy ,but thrombolysis brought more bleeding .In long term（〉6 m） outcomes ,the post thrombotic syndrome rate was less both in the thrombolysis group and the thrombectomy ,and catheter directed thrombolysis could diminish the vein obstruction rate .