下肢深静脉血栓形成导管接触溶栓与外周静脉系统溶栓早期疗效的对比研究

Comparative Study of Short-term Therapeutic Effects of Catheter-directed Thrombolysis and Peripheral Systemic Thrombolysis for Lower Extremity Deep Vein Thrombosis

目的探讨经不同途径导管接触溶栓（catheter-directed thrombolysis,CDT）和外周静脉系统溶栓治疗下肢深静脉血栓形成（deep venous thrombosis,DVT）的疗效。方法回顾性分析2010年1月~2015年11月我科85例DVT的临床资料,其中CDT组47例（动脉CDT组25例,静脉CDT组22例）,静脉系统溶栓组38例,3组均在抗凝基础上给予尿激酶100万U/d持续泵入,CDT组同期行下腔静脉临时滤器植入术,比较3组患肢深静脉溶栓率、消肿率和并发症发生率。结果中央型DVT血栓溶栓率静脉CDT组最高（81.3±18.4）%,显著高于动脉CDT组（45.1±17.6）%（q=6.648,P〈0.05）和静脉系统溶栓组（32.1±10.1）%（q=9.524,P〈0.05）。周围型DVT血栓溶栓率动脉CDT组最高（66.7±22.3）%,与静脉CDT组（45.8±21.7）%无统计学差异（q=2.807,P〉0.05）,但显著高于静脉系统溶栓组（43.7±15.2）%（q=3.614,P〈0.05）。混合型DVT血栓溶栓率3组间有统计学差异,其中静脉CDT组最高（71.7±18.2）%,显著高于动脉CDT组（55.1±9.3）%（q=3.714,P〈0.05）和静脉系统溶栓组（38.6±12.5）%（q=7.817,P〈0.05））。静脉CDT组消肿率（61.7±19.1）%,显著高于动脉CDT组（41.2±10.1）%（q=7.157,P〈0.05）和静脉系统溶栓组（33.6±12.2）%（q=10.540,P〈0.05）。3组并发症发生率分别为12.0%（3/25）、9.1%（2/22）、22.6%（8/35）,无统计学差异（χ2=2.319,P=0.314）。结论 CDT治疗下肢DVT疗效好于外周静脉系统溶栓。中央型和混合型DVT,静脉CDT为首选方案;周围型DVT,动脉CDT疗效优于静脉途径。

Objective To investigate effects of catheter-directed thrombolysis（ CDT） and peripheral systemic thrombolysis in the treatment of deep vein thrombosis（ DVT）. Methods Data of a total of 85 patients with DVT from January 2010 to November2015 were analyzed retrospectively. Of all the patients,47 cases were treated with CDT（ through artery in 25 cases and vein in 22cases） and 38 cases were treated with peripheral systemic thrombolysis through the limb dorsal vein. All the cases were given urokinase（ 1 000 000 U/d） for anticoagulation. The CDT patients were simultaneously given inferior vena cava filter placement. The deep vein thrombolysis rate,limb swelling remission rate and complication rate were evaluated among the three groups. Results For central type DVT,the venous CDT group had the highest thrombolysis rate of deep vein（ 81. 3 ± 18. 4） %,which was significantly higher than that in the arterial CDT group（ 45. 1 ± 17. 6） %（ q = 6. 648,P 〈 0. 05） and peripheral group（ 32. 1 ± 10. 1） %（ q = 9. 524,P 〈0. 05）. For peripheral type DVT,the arterial CDT group had the highest thrombolysis rate of deep vein（ 66. 7 ± 22. 3） %,which had no significant difference with venous CDT group（ 45. 8 ± 21. 7） %（ q = 2. 807,P 〉 0. 05） and was significantly higher than that in the peripheral group（ 43. 7 ± 15. 2） %（ q = 3. 614,P 〈 0. 05）. For mixed type DVT,the venous CDT group had the highest thrombolysis rate of deep vein（ 71. 7 ± 18. 2） %,which was significantly higher than that in the arterial CDT group（ 55. 1 ± 9. 3） %（ q = 3. 714,P 〈 0. 05） and peripheral group（ 38. 6 ± 12. 5） %（ q = 7. 817,P 〈 0. 05）. The swelling remission rate of leg in the venous CDT group（ 61. 7 ± 19. 1） % was significantly higher than that in the arterial CDT group（ 41. 2 ± 10. 1） %（ q = 7. 157,P 〈 0. 05） and peripheral group（ 33. 6 ± 12. 2） %（ q = 10. 540,P 〈 0. 05）. The complication rates of the three groups were 12. 0%（ 3 /25）,9. 1%（ 2 /22）,and 22. 6%（ 8 /35）,respectively,with no significant differences（ χ2= 2. 319,P = 0. 314）. Conclusions The results of CDT for DVT are better than those of systemic thrombosis. Performance of CDT through vein is the first choice for central and mixed type DVT and CDT through artery is better for peripheral type DVT.