老年急性下肢深静脉血栓形成患者腔内综合治疗的研究

Clinical study of comprehensive endovascular treatment for acute deep vein thrombosis in elderly patients

目的探讨老年急性下肢深静脉血栓形成(DVT)患者采用腔内综合治疗的安全性和临床疗效。方法回顾性分析2013年06月至2016年06月间我科采用腔内治疗的94例老年DVT患者的临床资料。患者均行下腔静脉滤器置入术(IVCF),57例采用血栓减容后辅助导管溶栓(CDT)治疗(血栓减容+CDT组),37例CDT治疗(CDT组)。观察老年DVT患者各种治疗方法的有效性和安全性。结果94例患者可回收IVCF 88例,取出率为94.3%(83/88)。血栓减容+CDT组和CDT组患者溶栓持续时间分别为(73.9±31.7)h和(156.2±30.2)h,灌注溶栓药物总量(180.71±44.83)万单位和(355.0±96.0)万单位(均P<0.05);平均住院时间(9.4±2.4)d和(12.8±4.3)d(t=-4.99,P<0.01);出院时两组疗效比较差异无统计学意义(χ2=1.263,P>0.05);56例患者行血管成形术(PTA),其中34例同时联合置入支架,两组比较差异无统计学意义(χ2=1.128,P>0.05);未发生严重并发症,小出血发生率为9.6%(9/94),血栓减容+CDT组和CDT组分别2例和7例(χ2=4.503,P=0.034)。94例患者平均随访时间(16.7±8.3)个月,髂静脉支架通畅率为91.2%(31/34),末次随访多普勒超声结果显示瓣膜反流率为20.2%(19/94),血栓减容+CDT组和CDT组血栓后综合征发生率比较,差异无统计学意义(χ2=0.307,P=0.580)。血栓减容+CDT组和CDT组患者Villata评分轻、中和重度分别为9例比6例、4例比5例、0例比1例(均P>0.05)。结论及时合理选择治疗策略,综合运用IVCF置入术、抗凝、腔内CDT、血栓减容、PTA术和腔内支架置入术等手段,对老年DVT患者安全、有效。

Objective To investigate the safety and clinical efficacy of comprehensive endovascular treatment for acute deep vein thrombosis(DVT)in elderly patients.Methods Clinical data of 94 elderly patients who underwent endovascular treatment from June 2013 to June 2016 were retrospectively analyzed.All patients underwent inferior vena cava filter implantation(IVCF).Of them,57 patients initially underwent thrombectomy and subsequently received the adjunctive catheter-directed thrombolysis(CDT)(Group A)and 37 cases underwent CDT(Group B).Clinical efficacy and safety of treatments in the two groups were examined.Results Among the 94 patients,88 cases had retrievable IVCF,and the retrieval rate was 94.3%(83/88).There were significant differences in total infusion time(73.92±31.68 h vs.156.2±30.2 h)and total doses of infused thrombolytic agents(180.71±44.83 million unit vs.355.0±96.0 million unit)between Groups A and B(P<0.05).There was a significant difference in average hospitalized time between Groups A and B(9.4±2.4 d vs.12.8±4.3 d,t=-4.99,P<0.01).There was no significant difference in clinical efficacy between Groups A and B(χ2=1.263,P>0.05).Fifty-six patients were treated with angioplasty(PTA),34 of them were combined with stent implantation,and there was no difference between the two groups(χ2=1.128,P>0.05).Neither of the two groups saw serious complications.The incidence of minor hemorrhage was 9.6%(9/94),including 2 cases and 7 cases in Group A and Group B respectively,and the difference was statistically significant(χ2=4.503,P=0.034).The average follow-up time was 16.7±8.3 months in the 94 patients,and the stent patency rate was 91.2%(31/34).Doppler ultrasonography results at the last follow-up showed that the reverse flow rate of the valve was 20.2%(19/94),the occurrence rates of post-thrombotic syndrome(PTS)were 24.6%(14/57)and 29.7%(11/37)in Group A and Group B respectively,and the difference was not statistically significant(χ2=0.307,P=0.580).Patients in the mild,moderate and severe stages assessed by Villata scoring were 9 vs.6,4 vs.5,0 vs.1 in Group A and Group B respectively,and the differences were not statistically significant(χ2=0.007 and 0.205,P>0.05).Conclusions It is safe and effective for elderly patients with DVT when timely and appropriate the treatment strategies are chosen and comprehensive approaches including IVCF,anticoagulation,endovascular CDT,thrombectomy,PTA and stent implantation are used.