经大隐静脉入路行导管溶栓治疗急性下肢深静脉血栓的可行性

Feasibility of catheter-directed thrombolysis through great saphenous vein in treatment of acute lower extremity deep vein thrombosis

目的评估经大隐静脉入路行急性下肢深静脉血栓置管溶栓治疗的可行性。方法收集70例急性下肢深静脉血栓患者,随机分为A、B两组,A组为实验组(n=35),采用大隐静脉入路置管溶栓,B组为对照组(n=35),采用传统腘静脉入路置管溶栓。评估A、B两组患肢的消肿率、溶栓率、并发症发生率、手术时间。结果 70例均为单侧下肢急性深静脉血栓,A、B两组的患肢消肿率分别为(80.11±4.02)%、(81.70±6.13)%,差异无统计学意义(F=0.723,P=0.89);溶栓率分别为(84.91±3.40)%、(87.72±4.73)%,差异无统计学意义(F=0.685,P=0.71);手术时间分别为(3.91±0.74)min、(4.31±1.13)min,并发症发生率分别为2.86%(1/35)、5.71%(2/35),差异均无统计学意义(P均>0.05),A组1例出现隐神经损伤,B组2例并发腘窝血肿。结论经大隐静脉入路置管溶栓治疗急性下肢深静脉血栓可行,可作为常规腘静脉入路的有益补充。

Objective To evaluate the feasibility of catheter-directed thrombolysis （CDT） through great saphenous vein for acute lower extremity deep venous thrombosis （DVT）. Methods A total of 70 patients with acute DVT were enrolled, and were divided into group A and group B in accordance with the principle of randomization. Group A were performed CDT through the great saphenous vein as the experimental group （n=35）, and group B were performed CDT via the pop- liteal vein as the control group （n= 35）. The limb edema reduction rates, thromblytic rates, complication rates and the op- eration time between group A and group B were evaluated. Results All of the 70 cases were all single acute DVT. The differences of limb edema reduction rates （[80.11 ± 4. 02] % vs [81.70 ± 6.13] %, F = 0. 723, P = 0. 89）, thromblytic rates （[84. 91±3.40]% vs [87.72 ± 4. 73]%, F= 0. 685, P = 0.71）, operation time （[3.91 ± 0.74] rain vs [4.31 ±1.13]min, t=1.995, P=0.074） and the complication rates （2.86% [1/35] vs 5.71% [2/35], X2=0.343, P=0.558） were not statistically significant between group A and group B. The complication included one case of saphenous nerve inju- ry in group A, and two cases of popliteal fossa hematoma in group B. Conclusion Catheter-directed thrombolysis through the great sphaneous vein is simple and effective in treatment of acute lower extremity DVT, and is a beneficial supplemental method of catheterisation via popliteal vein.