导管碎栓联合置管溶栓治疗下肢深静脉血栓

Catheter thrombectomy and catheter-directed thrombolysis for deep venous thrombosis

目的评价导管碎栓、抽栓联合置管溶栓对下肢深静脉血栓的疗效。方法回顾性分析2015年1月至2016年2月60例急性下肢深静脉血栓患者的临床资料。健侧股静脉或右侧颈内静脉入路置入下腔静脉滤器，将5FPigtail导管“翻山”引至患侧深静脉内，推注尿激酶并旋转抽拉导管碎栓．配合10-12F大腔导管抽栓，然后留置导管持续泵入尿激酶溶栓。测量术前健侧肢体大腿及小腿的周径，患侧肢体大腿及小腿术前及术后的周径．比较患侧肢体手术前后周径的变化来判断溶栓的疗效：监测弥散性血管内凝血（disseminated intravascular coagulation，DIC）指标来评价置管溶栓的安全性及有效性。结果治疗效果：治愈45例，显效8例，有效5例，无效2例，治疗有效率96．6％。溶栓前患侧与健侧大腿周径差（3．6±1．9）cm（P〈0．05），小腿周径差（4．6±2．1）cm（P〈0．05）；溶栓后患侧与健侧大腿周径差（0．19±0．90）cm（P〉0．05），小腿周径差（0．5±1．0）cm（P〉0．05）。结论导管碎栓、抽栓联合置管溶栓治疗下肢深静脉血栓是安全有效的。

Objective To evaluate catheter thrombectomy, mechanical thromboaspiration and catheter-directed thrombolysis for the treatment of deep venous thrombosis. Methods From January 2015 to February 2016, 60 patients with acute deep vein thrombosis were placed the inferior vena cava tilter from contralateral femoral vein or right internal jugular vein. A 5 F pigtail catheter was led to the ipsilateral deep vein, bolus urokinase was given and catheter thrombectomy was undertaken and thromboaspiration was carried out using 10 - 12 F catheter,then through catheter continuous infusion of urokinase. Results 45 cases were cured, 8 cases were significantly improved, 5 cases were improved, 2 cases were judged as ineffective, the effective rate was 96. 6%. Before thrombolysis the thigh circumference difference between affected limb and the contralateral limb was （3.6 -＋ 1.9）cm （P 〈0. 05）, calf circumference difference was （4. 6 -＋2. 1 ） cm （P 〈 O. 05 ）;The difference between the affected limb and contralateral thigh circumferences was （0.19＋0.90） cm （P 〉0.05）, calf circumference difference was （0.5 ＋ 1.0） cm （P 〉 0.05）. Conclusions Catheter thrombectomy, thromboaspiration and catheter-directed thrombolysis for deep venous thrombosis is safe and effective.