导管直接溶栓联合腔内治疗在急性下肢深静脉血栓形成中的中远期疗效分析

Mid-and long-term outcome of catheter-directed thrombolysis combined with endovascular therapy in acute deep venous thrombosis

目的探讨导管直接溶栓(CDT)联合腔内治疗在急性下肢深静脉血栓形成(DVT)中的中远期疗效。方法收集2012年7月至2015年6月本科收治的278例急性下肢DVT患者(307条患肢)的临床资料。对单纯抗凝治疗组和CDT联合腔内治疗组的临床疗效进行回顾性分析。结果CDT联合腔内治疗组血栓形成后综合征(PTS)发生率(15.6%)明显低于单纯抗凝治疗组(47.3%),差异有统计学意义(U=5925.500,P<0.001)。CDT联合腔内治疗组的慢性静脉功能不全生活质量问卷调查表(CIVIQ)、静脉临床严重程度评分(VCSS)、静脉瓣膜功能优于单纯抗凝治疗组,差异均有统计学意义(U=5639.500、5951.000、2718.000,P均<0.001)。两组的血栓复发率差异无统计学意义(χ~2=1.290,P=0.256)。结论 CDT联合腔内治疗较单纯抗凝治疗能更好地改善DVT患者临床症状,提高生活质量,降低急性下肢DVT转归为PTS的发生率,值得在临床上推广应用。

Objective To explore the mid- and long-term outcome of catheter-directed thrombolysis （CDT） combined with endovascular therapy in acute lower extremity deep venous thrombosis （DVT）. Methods The clinical data of 278 patients with acute lower extremity DVT （307 limbs） were collected ＆om July 2012 to June 2015 in our department The clinical outcome of anticoagulation group and CDT combined with endovascular therapy group was retrospectively analyzed. Results The rate of post-thrombotic syndrome （PTS） in CDT combined with endovascular therapy group （15.6%） was significantly lower than that in anticoagulation group （47.3%） （f/=5925.500, P〈0.001）. The CDT combined with endovascular therapy group of chronic venous insufficiency quality of life questionnaire （CIVIQ）, venous clinical severity score （VCSS）, venous valve function were significanlly better than anticoagulation therapy group （Z7=5639.500, 5951.000, 2718.000, all P〈0.001）. There was no significant difference in thrombus recurrence rate between the two groups （χ2=1.290, P=0.256）. Conclusions Compared with anticoagulation therapy, CDT combined with endovascular therapy can improve the clinical symptoms, the quality of life, and reduce the rate of PTS greatly, and it is worthy of clinical application.