高频彩超引导下经腘静脉置管治疗下肢深静脉血栓

High frequency color Doppler ultrasound-guided popliteal venous catheter-directed thrombolysis for deep venous thrombosis

目的探讨高频彩超引导下经腘静脉穿刺置管直接溶栓治疗下肢深静脉血栓的疗效。方法将55例下肢深静脉血栓患者随机分为置管组（20例）和对照组（35例）。置管组行实时超声引导下经患侧腘静脉穿刺，将溶栓导管放于含有血栓的目标静脉内，经静脉泵持续泵入尿激酶；对照组采用经外周浅静脉滴入尿激酶溶栓，比较两组的疗效。结果置管组中1例患者因静脉穿刺失败，改为经外周浅静脉给药治疗，归入对照组。置管组药物起效时间快，19例患肢肿胀消退或减轻，有效率为100％（19／19）；对照组药物起效时间相对较慢，26例患肢肿胀消退或减轻，有效率为75％（27／36），9例治疗无效；置管组疗效优于对照组（Z=-4．210，t9=0．000）。溶栓治疗后，置管组患者肢体肿胀明显缓解，置管组和对照组患者大腿和小腿周径差[（5．39±1．08）、（4．56±0．56）cm比（2．97±0．98）、（2．65±0．65）cm]比较差异均有统计学意义（P均=0．000）。所有患者出院后随访3～36个月，置管组远期并发症少于对照组。结论高频彩超引导下经胭静脉穿刺置管直接溶栓治疗下肢深静脉血栓是一种微创、简单易行、安全、疗效确切且并发症少的方法。

Objective To investigate therapeutic effect of the high frequency ultrasound-guided popliteal venous catheter-directed thrombolysis on deep venous thrombosis. Methods Fifty-five patients with deep venous thrombosis were randomly divided into catheter group （20 cases） and control group （35 cases）. In catheter group, under the guidance of ultrasound the thrombolytic catheter was placed into the target vein which had thrombosis via ipsilateral popliteal vein, and the urokinase was constantly infused by vein pump. In control group, deep venous thrombosis was dissolved by urokinase via peripheral superficial vein. Curative effects of two groups were compared. Results One patient in catheter group was allocated into control group and treated with urokinase via peripheral superficial vein due to failed puncture. In catheter group, drug onset time was fast, and 19 cases of limb swelling obviously decreased or were relieved, the efficiency was 100% （19/19）. In control group, drug onset time was relatively slow, 26 cases of limb swelling obviously decreased or were relieved, the efficiency was 75 % （27/36）, with 9 cases of inefficiency. There was a significant difference in therapeutic effect between the two groups （Z = - 4. 210 ,P = 0. 000）. After treatment, limb swelling alleviated more significantly in catheter group than that in control group. The differences in limb thigh and calf circumferences between catheter group and control group [ （5.39 ± 1.08 ）, （4.56 ± 0. 56） cm vs. （2.97 ± 0. 98 ）, （2.65 ± 0.65 ） cm ] were statistically significant （ all P = 0. 000）. All patients were followed up for 3 - 36 months after discharge.Compared with control group, there were fewer complications in catheter group. Conclusions Itigh frequency color Doppler ultrasound-guided popliteal venous catheter-directed thrombolysis in treatment of deep venous thrombosis is minimally invasive, simple, safe and effective with less complications.