机械性血栓抽吸和置管溶栓对87例急性中央型下肢深静脉血栓静脉功能的影响

Effects of mechanical thrombus aspiration and catheter-directed thrombolysis on venous function in 87 cases of acute central deep venous thrombosis of lower extremity

目的回顾性分析机械性血栓抽吸与置管溶栓(CDT)对急性中央型下肢深静脉血栓静脉功能的影响。方法选取2015年1月至2017年1月急性中央型深静脉血栓(DVT)患者87例,其中男45例,女42例。血栓抽吸组39例,采用大导管或者鞘管行血栓抽吸,术后辅以小剂量尿激酶溶栓治疗。CDT组48例,采用溶栓导管行血栓接触式溶栓,比较两组治疗后6个月,1、2年的股浅静脉有效内径、股浅静脉第一对瓣膜血液返流时间、返流距离和出院后血栓后综合征(PTS)的发生概率。结果术后数据分析显示,两组间股浅静脉直径差异有统计学意义(F处理=10 197.500,P<0.001),治疗后6个月,1、2年间差异有统计学意义(F时间=442.770,P<0.001),同时处理方法与时间因素间存在协同的交互效应(F处理×时间=317.749,P<0.001)。两组间股浅静脉瓣膜返流时间差异有统计学意义(F处理=14 529.193,P<0.001),治疗后6个月,1、2年差异有统计学意义(F时间=670.189,P<0.001),同时处理方法与时间因素间存在协同的交互效应(F处理×时间=501.604,P<0.001)。两组间股浅静脉血液返流距离差异有统计学意义(F处理=4 842.897,P<0.001),治疗后6个月,1、2年间差异有统计学意义(F时间=413.343,P<0.001),同时处理方法与时间因素间存在协同的交互效应(F处理×时间=313.582,P<0.001)。在随访期内,CDT组PTS发生概率[35.42%(17/48)]与血栓抽吸组[15.40%(6/39)]差异有统计学意义(χ2=106.350,P<0.001)。结论机械性血栓抽吸可以早期扩大股浅静脉有效管腔,减轻瓣膜处血液返流时间和距离,降低远期PTS发生概率,较CDT可以有效保护静脉功能。

Objective To explore the effects of mechanical thrombus aspiration and catheter-directed thrombolysis(CDT) on venous function of acute central deep venous thrombosis(DVT). Methods A total of 87 patients with acute central DVT treated during Jan. 2015 and Jan. 2017 were selected, including 45 males and 42 females. The patients were divided into 2 groups: mechanical group(n=39, thrombus aspiration with big catheter or sheath, supplemented with small dose of urokinase after operation), and CDT group(n=48). The effective internal diameter of superficial femoral vein(SFV), time of blood regurgitation of the first valve in SFV, reflux distance, and incidence of post-discharge postthrombotic syndrome(PTS) were compared 6 months, 1 year and 2 years after treatment. Results Therewas significant difference in the diameter of SFV between the two groups(Ftreatment=10 197.500, P<0.001), the differences 6 months, 1 year and 2 years were statistically significant(Ftime=442.770, P<0.001), and there was a synergistic interaction effect between the treatment method and time(Ftreatment×time=317.749, P<0.001). There was significant difference in valvular regurgitation time between the two groups(Ftreatment=14 529.193, P<0.001), the differences 6 months, 1 year and 2 years were significant(Ftime=670.189, P<0.001), and there was a synergistic interaction effect between treatment method and time(Ftreatment×time=501.604, P<0.001). There was significant difference in reflux distance between the two groups(Ftreatment=4 842.897, P<0.001), the differences 6 months, 1 year and 2 years were significant(Ftime=413.343, P<0.001), and there was a synergistic interaction effect between the treatment method and time(Ftreatment×time=313.582, P<0.001). The incidence of PTS was [35.42%(17/48)] in CDT group, and [15.40%(6/39)] in the mechanical group, with statistical difference(χ2=106.350, P<0.001). Conclusion Mechanical thrombus aspiration can expand the cavity of SFV in the early stage, reduce the time and distance of blood reflux at the valve, reduce the incidence of long-term PTS, and better protect the venous function compared with CDT.