下肢深静脉血栓形成介入溶栓治疗的疗效

Interventional Thrombolytic Therapy for Lower Limb Deep Venous Thrombosis

目的探讨下肢深静脉血栓形成（deep venous thrombosis）介入溶栓治疗的疗效。方法 2012年2月~2014年10月101例DVT可回收型下腔静脉滤器置入后经腘静脉顺行穿刺,置入溶栓导管,经溶栓导管尿激酶进行溶栓,通过溶栓导管造影了解血栓溶解情况,决定溶栓时间及尿激酶剂量。结果术后1周溶栓效果Ⅰ级87例（87/101,86.1%）,Ⅱ级8例（8/101,8.0%）,Ⅲ级6例（6/101,5.9%）;痊愈80例（80/101,79.2%）,有效21例（21/101,20.8%）。术后2周溶栓效果Ⅰ级95例（95/101,94.1%）,Ⅱ级6例（6/101,5.9%）;痊愈90例（90/101,89.1%）,有效11例（11/101,10.9%）。5例复发2~3次,其中出院后1个月内3例复发,1~2个月内3例复发（1例第2次复发）,2~3个月复发3例（1例第2次复发）,3~6个月复发3例（2例第2次复发,1例第3次复发）,以上5例考虑为易栓症,每次溶栓后治愈,长期口服华法林,并坚持定期门诊复查。截止2014年10月,101例随访3~30个月,平均10.7月,均未见支架移位、支架内血栓形成、狭窄、闭塞等。结论介入溶栓治疗具有有效预防肺栓塞、创伤小、痊愈快、卧床时间短及血栓后遗症明显减少等优点。

Objective To investigate the curative effect of interventional thrombolytic therapy for lower limb deep venous thrombosis（ DVT）. Methods From February 2012 to October 2014,a total of 101 cases of lower limb DVT were treated. After the placement of a recyclable inferior vena cava filter,an antegrade puncture was conducted through the popliteal vein to insert a thrombolytic catheter,by which urokinase was given and then radiography was performed to evaluate thrombolytic outcome and determine thrombolytic time and urokinase dosage. Results At the first postoperative week,the thrombolytic outcome was classified as grade Ⅰ in 87 cases（ 87 /101,86. 1%）,grade Ⅱ in 8 cases（ 8 /101,8. 0%）,and grade Ⅲ in 6 cases（ 6 /101,5. 9%）. There were 80 cases of ＂ cured＂（ 80 /101,79. 2%） and 21 cases of ＂ effective＂（ 21 /101,20. 8%）. At the second postoperative week,the thrombolytic outcome was classified as grade Ⅰ in 95 cases（ 95 /101,94. 1%） and grade Ⅱ in 6 cases（ 6 /101,5. 9%）. There were90 cases of ＂ cured＂（ 90 /101,89. 1%） and 11 cases of ＂ effective＂（ 11 /101,10. 9%）. Recurrence for 2- 4 times happened in 5cases,including 3 cases occurred within 1 month after discharge,3 cases occurred at 1- 2 months after discharge（ second recurrence in 1 case）,3 cases occurred at 2- 3 months after discharge（ second recurrence in 1 case）,and 3 cases occurred at 3- 6 months after discharge（ second recurrence in 2 cases and third recurrence in 1 case）. The above 5 cases were diagnosed as having thrombophilia,and were given long-term oral administration of warfarin and regular outpatient review. As of October 2014,all the 101 cases were followed up for 3- 30 months（ mean,10. 7 months）,without stent displacement,stent thrombosis,stricture,or obstruction.Conclusion Interventional thrombolytic therapy has advantages of preventing pulmonary embolism,minimal invasion,rapid recovery,short bed rest time,and significantly decreases embolism sequela.