导管接触溶栓治疗急性和亚急性下肢深静脉血栓临床疗效分析

Therapeutic effect of catheter-directed thrombolysis for acute and subacute lower limb deep venous thrombosis

目的评估导管接触溶栓(CDT)治疗急性和亚急性下肢深静脉血栓形成(DVT)的临床疗效。方法回顾性分析2012年3月至2017年5月扬州大学附属医院血管外科收治的40例DVT患者的临床资料,其中CDT组17例,外周静脉溶栓组23例,比较2组患者治疗前后患肢和健肢的大、小腿周径差,患肢消肿率,患肢静脉通畅度评分,溶栓后患肢的静脉通畅率;随访1～62个月,根据Villalta评分对治疗后患者血栓形成后综合征(PTS)的发生做出诊断。结果 40例患者的肢体肿胀均不同程度消退,无出血、肺栓塞(PE)、感染、血栓复发等并发症。2组患者治疗后大腿和小腿健、患侧的肢体周径差明显小于治疗前,CDT组比静脉溶栓组更明显;2组患者治疗后造影复查显示,静脉通畅评分比治疗前明显减小,CDT组比静脉溶栓组更明显;随访结果显示,CDT组与静脉溶栓组患者的Villalta评分分别为(3.06±0.78)分、(4.22±0.61)分,2组比较差异有统计学意义(P<0.05);PTS发生率分别为(2/17,11.76%)、(6/23,26.09%),静脉溶栓组高于CDT组,差异有统计学意义(P<0.05)。结论 CDT治疗急性、亚急性下肢DVT,创伤小、疗效明显、安全性高,值得在临床进一步推广。

Objective To evaluate the feasibility and efficacy of catheter-directed thrombolysis（CDT） approach in treating acute and subacute deep venous thrombosis（DVT） of the lower limbs. Methods The clinical data of 40 patients with DVT of the lower limb treated in vascular surgery department in the affiliated hospital of Yangzhou university from March 2012 to May 2017 were retrospectively analyzed. The patients were divided into CDT group（17 cases） and intravenous thrombolysis group（23 cases）, limb swelling rate, venous patency rates, circumference difference between suffered limb and healthy one and venous patency score before and after treatment were compared and calculated. All patients were followed by 1 month to 62 months, according to the Villalta score; the post-thrombotic syndrome（PTS） in patients after treatment was evaluated. Results All patients with limb swelling achieved varying degrees of regression, no haemorrhage, pulmonary embolism（PE）, infection, thrombosis recurrence and other complications. Preoperative and postoperative thigh/calf circumference difference and venous patency score were significantly regressed, especially in the CDT group. The follow-up showed Villalta score of CDT group（3.06±0.78） and intravenous thrombolysis group（4.22±0.61） significantly different（P〈0.05）, both notably depressed after treatment. The PTS incidence of intravenous thrombolysis group（6/23, 26.09%） was higher than that of CDT group（2/17, 11.76%）, the difference was statically significant（P〈0.05）. Conclusions CDT is a reliable, safe and minimally invasive surgery, and has a long-term effect in treating acute and subacute DVT of the lower limbs.