不同压力球囊扩张治疗急性下肢深静脉血栓形成

Balloon Dilatation with Different Pressure for Acute Deep Venous Thrombosis of Lower Extremity

目的探讨球囊扩张(BD)治疗急性下肢深静脉血栓形成(DVT)的中远期疗效。方法收集2015年1月~2018年12月收治的83例急性下肢DVT患者行导管接触溶栓治疗(CDT)的临床资料,分为CDT组(A组)、CDT+低压力BD组(B组)、CDT+足压力BD组(C组),通过随访症状及生活质量回顾性分析三组治疗效果。结果共28例放置腔静脉滤器;55例患者放置60枚支架。三组患者血栓溶解率比较,差异无统计学意义(P=0.928);大腿、小腿周径下降程度比较,差异均无统计学意义(P=0.489、P=0.452)。术后6个月三组患者Villalta评分、CIVID-2评分比较,差异均无统计学意义(P>0.05);术后12个月Villalta评分A、B组比较差异无统计学意义(P=0.083)、A组低于C组(P=0.008),CIVID-2评分A组高于B组(P=0.01)、A、C组差异无统计学意义(P=0.092);术后18个月Villalta评分A、C组差异无统计学意义(P=0.211),CIVID-2评分A组低于C组(P=0.036);余结果符合C组大于B组,A组大于B组,C组大于A组。随访期间所有患者支架通畅率为80%,三组比较差异无统计学意义(P=0.769)。结论低压力球囊扩张治疗下肢DVT是安全、有效的方法,临床成功率高,远期疗效好;足压力球囊扩张增加PTS发生率。

Objective To explore the mid-and long-term outcome of balloon dilatation(BD)therapy for acute lower extremity deep venous thrombosis(DVT).Methods The clinical data of 83 patients with acute DVT treated by CDT were collected from January 2015 to December 2018 and analyzed retrospectively.All cases were divided into three groups:Group A(n=28)was treated by catheter directed thrombosis(CDT),Group B(n=44)by CDT+low pressure BD,and group C(n=11)by CDT+full pressure BD.The symptoms and quality of life were followed up and compared among the three groups.Results A total of 28 patients in the three groups were placed vena cava filter;55 patients were placed 60 stents.There was no statistically significant difference in thrombolysis rate among the three groups(P=0.928).There was no obviously significant difference in the degrees of circumference decrease of thigh and calf among the three groups(P=0.489,P=0.452).There was no statistical difference in the comparison of the Villalta score and CIVID-2 score among the three groups at 6 months after the operation(all P>0.05);At 12 months after the operation,there was no remarkable significant difference in the Villalta score between the group A and group B(P=0.083),and group A is lower than group C(P=0.008),CIVID-2 score is higher in group A than group B(P=0.01),but there is no statistically significant difference between groups A and C(P=0.092);18 Monthly Villalta scores had no statistically significant difference between groups A and C(P=0.211),CIVID-2 scores in group A were lower than group C(P=0.036);And the remaining results were consistent with group C being greater than group B,group A being greater than group B,amd group C is larger than group A.During the follow-up period,the patency rate of all patients was 80%,and there was no significant difference among the three groups(P=0.769).Conclusion The therapy of low pressure BD is safe and effective for DVT with higher clinical success rate and better long-term outcomes,but full pressure BD can increase the risk of PTS.