产后下肢深静脉血栓介入治疗后即刻疗效与长期预后分析

Early and long-term outcomes for postpartum deep vein thrombosis：the role of endovascular treatment

目的探讨产后下肢深静脉血栓形成（DVT）介入治疗的即刻疗效及长期预后。方法回顾性分析30例行介入治疗的产后DVT患者的临床资料、静脉造影结果及出院后3年内的随访结果。所有患者均采用导管接触性溶栓（CDT），必要时联合血栓抽吸术（MAT）及植入髂静脉支架。根据出院时静脉造影结果，将即刻溶栓效果分为3级评价（Ⅲ级：血栓清除〉95%；Ⅱ级：血栓清除50%～95%；Ⅰ级：血栓清除〈50%），血栓清除Ⅱ、Ⅲ级认为溶栓有效。将患者发病时间、分娩方式、患者年龄、是否合并髂静脉受压（IVCS）以及髂静脉是否植入架纳入统计分析，分析这些因素对即刻疗效的影响，统计学方法采用χ2检验。长期疗效采用生存分析计算血管通畅率。结果出院时30例患者中，血栓清除Ⅲ级14例、Ⅱ级12例、Ⅰ级4例。不同分娩方式、发病时间、患者年龄以及是否伴有IVCS对即刻疗效无影响（χ2值分别为0.88、1.28、1.15、3.08，P值均〉0.05），18例伴有IVCS患者中，7例植入支架者均即刻有效，11例未植入支架者即刻有效7例，两者间差异有统计学意义（χ2=5.14，P〈0.05）。随访1、3、6个月及1、2、3年显示：患者术后1、3、6月总体通畅率分别为86.7%、70.0%、66.7%，术后1、2、3年总体通畅率均为66.7%。伴有IVCS植入支架的7例均长期通畅与未植入支架者（长期通畅率36.4%）差异有统计学意义（χ2=6.562，P〈0.05）；伴有IVCS未植入支架者与无IVCS者（长期通畅率75.0%）差异有统计学意义（χ2=3.377，P〈0.05）；伴有IVCS植入支架者长期通畅率与无IVCS者长期通畅率差异无统计学意义（χ2=1.932，P〉0.05）。结论产后DVT患者采用CDT联合MAT治疗快速、安全有效。对于伴有IVCS的产后DVT患者，植入支架者的长期通畅率显著高于未植入支架者。

Objective To investigate the effect of endovascular treatment to initial and long-term outcomes of postpartum deep venous thrombosis （DVT） . Methods The clinical data, venography and 3-yaer follow up data of 30 female patients with acute or subacute deep vein thrombosis in the postpartum period who received endovascular therapy consisting of catheter-directed thrombolysis with angioplasty （stenting for some patients with iliac vein compression syndrome （IVCS）） were retrospectively evaluated. Clot removal was graded as grade Ⅲ（〉95%）, grade Ⅱ（50% to 95%）, and grade Ⅰ（〈50%）. Grade Ⅱ, Ⅲconsidered effective. Data from onset time, vaginal delivery or by elective, patients ages, IVCS or not and stenting or not were included in this analysis. And the χ2 test and survival analysis was used for statistical analysis of initial and long-term patency respectively. Results In 30 cases, the initial result included 14 cases（46.7%） of gradeⅢ, 12 cases（40.0%） of gradeⅡand 4 cases（13.3%） of gradeⅠ. Patients＆#39; onset time, vaginal delivery or by elective, patients ages and IVCS or not have no significant statistical difference to initial patency（χ2=0.88, 1.28, 1.15, 3.08,P〉0.05）.For 18 patients with IVCS, there was significant statistical difference between patients implanting stents（initial patency was 100.0%（7/7） and whom not 〈br〉 implanting stents（initial patency was 63.6%,7/11） （χ2=5.14, P〈0.05）. 1, 3, 6 months and 1, 2, 3 years follow-up showed： The primary patency of postoperative 1, 3, 6 months respectively were 86.7%, 70%（21/30）,66.7%（20/30）, and postoperative 1, 2, 3 years were all 66.7%. There was significant statistical difference between patients with IVCS implanting stents and whom not implanting stents （χ2=6.562, P〈0.05）, patients with IVCS not implanting stents and whom without IVCS （χ2=3.377, P〈0.05）. There was no significant statistical difference among patients with IVCS implanting stents and whom without IVCS（χ2=1.932, P〉0.05）. Conclusions Endovascular therapy consisting of catheter-directed thrombolysis with angioplasty could be considered as a primary therapeutic procedure in patients with acute or subacute postpartum DVT. Stenting for treatment of iliac compression which contributed to postpartum DVT is very valuable to ensuring higher long-term patency rate.