亚急性期下肢深静脉血栓形成抗凝与介入治疗的对比研究

Comparative study of anticoagulation and interventional therapy on subacute deep venous thrombosis of lower extremity

目的对比分析抗凝与介入治疗亚急性期下肢深静脉血栓形成(DVT)的疗效,探讨亚急性期下肢DVT的治疗选择。方法选取2014年1月至2016年1月在该院血管外科住院治疗的亚急性DVT患者48例,根据是否行介入治疗分为药物组和介入组,每组24例。药物组采用低分子肝素钙抗凝治疗,后期应用华法林或利伐沙班抗凝治疗。介入组在应用药物抗凝基础上行下腔静脉滤器植入,并经小隐静脉(9例)/腘静脉(15例)穿刺置入溶栓导管至静脉血栓中局部应用尿激酶溶栓。观察两组患者治疗前后患侧与健侧肢体周径差变化及疗效,随访6～24个月,观察DVT后综合征(PTS)发生情况等。结果介入组患者治疗后膝上、下患侧与健侧肢体周径差[分别为(1.10±1.11)、(1.11±1.02)cm]均明显小于药物组[分别为(2.21±1.04)、(2.00±0.98)cm],差异均有统计学意义(t=3.02、2.59,P<0.05);总有效率[91.7%(22/24)]明显高于药物组[54.2%(13/24)],差异有统计学意义(χ~2=8.545 1,P<0.05)。48例患者中完成随访43例,失访5例,随访率为89.6%。介入组患者中再发血栓1例,药物组患者中再发血栓3例。介入组患者总PTS发生率[13.6%(3/22)]明显低于药物组[52.4%(11/21)],差异有统计学意义(χ~2=7.345 2,P<0.05)。结论介入治疗亚急性期下肢DVT可提高血栓溶解率,降低PTS发生率。

Objective To compare and analyze the effects of anticoagulant and interventional therapy for subacute deep vein thrombosis (DVT) of lower extremities,and to investigate the therapeutic selection for subacute DVT of lower extremities. Methods 48 patients with subacute DVT of lower extremity treated in Department of Vascular Surgery in the hospital from January 2014 to January 2016.were selected in the study.There were two groups according to whether performed interventional therapy:drug group( n =24),and interventional group ( n =24).The drug group was treated with anticoagulation of low molecular heparin calcium,and then warfarin or livaroxaban.In the interventional group,inferior vena cava filter was implanted on the basis of drug anticoagulant,the Urokinase was applied vied thrombolytic catheter which was inserted through the saphenous vein (9 cases)/popliteal vein (15 cases).The difference of leg circumferences between the two groups before and after treatment,and therapeutic evaluation were observed.Follow-up observation was performed to assess the occurrence of postthrombotic syndrome (PTS). Results After treatment,the difference of limb circumference between the affected and healthy sides in the intervention group [(1.10±1.11)cm and (1.11±1.02)cm] was significantly smaller than that in the drug group [(2.21±1.04)cm and (2.00±0.98)cm],and the differences were statistically significant ( t =3.02,2.59;P <0.05).The total effective rate in the control group [91.7%(22/24)] was higher than that in the drug group [54.2%(13/24)],and the difference was statistically significant (χ^2=8.545 1, P <0.05).In 48 patients,follow-up was finished in 43 cases,5 were unfinished,and the follow-up rate was 89.6%.One case had recurrent thrombosis in the interventional group,and 3 cases had recurrent thrombosis in the control group.The total PTS occurrence rate in the interventional group [13.6%(3/22)] was lower than that in the drug group [52.4%(11/21)],and the difference was statistically significant (χ^2=7.345 2, P <0.05). Conclusion Interventional treatment of subacute DVT of lower extremity can improve the dissolution rate and reduce the incidence of PTS.