AngioJet血栓抽吸在下肢深静脉血栓形成中的治疗体会

Angio Jet thrombus aspiration in the treatment of deep venous thrombosis of lower extremity

目的评估Angio Jet机械血栓抽吸在下肢深静脉血栓形成治疗中的疗效和安全性。方法回顾分析2015年11月至2017年6月潍坊医学院附属医院收治的65例急性下肢深静脉血栓形成(DVT)患者,均行Angio Jet机械血栓抽吸治疗。术后对部分残余血栓行导管溶栓或单纯抗凝治疗。对合并Cockett综合征患者,髂静脉受压,行髂静脉支架置入治疗。术后抗凝治疗的时间为3~12个月。在Angio Jet机械抽吸血栓后,观察静脉通畅率、术中出血量、肺栓塞发生率、术后肌酐等指标情况,评估其安全性。结果在65例患者中28例未合并Cockett综合征,37例合并Cockett综合征,吸栓后即时静脉开通率分别为85.7%、67.6%,治疗前后静脉开通率比较,差异均有统计学意义(P<0.05)。在继续溶栓24~48 h后,静脉开通率分别为100%、89.2%。术中3例患者出现轻度肺栓塞,均为滤器下方喷药溶栓时出现,在停止操作后缓解。术后28例患者出现不同程度的血红蛋白尿,6~18 h均恢复正常。未出现明显血红蛋白下降、肾功能损害病例,未发生术中和术后出血导致治疗中止病例。结论应用Angio Jet机械血栓抽吸治疗下肢DVT安全有效,尤其适用于存在溶栓禁忌的患者。

Objective To evaluate the efficacy and safety of Angio Jet mechanical thrombus aspiration in the treatment of deep venous thrombosis of lower extremity. Methods From November 2015 to June 2017, 65 patients with acute deep venous thrombosis（DVT） were treated with Angio Jet mechanical thrombus aspiration. Thrombolysis or anticoagulant therapy was performed on some residual thrombus after operation. The patients with Cockett syndrome underwent iliac vein stent implantation. Postoperative anticoagulation was performed in 3-12 months. After Angio Jet, the rate of venous patency, intraoperative blood loss, the incidence of pulmonary embolism, and the level of creatinine were observed and the safety of Angio Jet was evaluated. Results There were no Cockett syndrome in 28 cases, and 37 cases with Cockett syndrome in 65 cases, and the immediate venous patency rate was 85.7%, 67.6%. Patency rate before and after treatment was compared, the difference was statically significant（P〈0.05）. After thrombolysis for 24-48 hours, the patency rate was 100%, 89.2%. 3 cases of mild pulmonary embolism during operation, there were filters below the spraying stop operation relieved after thrombolysis. After operation, 28 cases had different degrees of hemoglobin, and 6-18 hours returned to normal. There was no significant decrease in hemoglobin, renal function damage cases, no intraoperative and postoperative bleeding led to discontinuation of treatment. Conclusion Angio Jet mechanical thrombus aspiration is safe and effective in the treatment of deep venous thrombosis of lower extremity, especially suits for patients with contraindications for thrombolysis.