不同置管入路溶栓治疗急性下肢深静脉血栓形成的应用效果

The effects of different approaches for catheter-directed thrombolysis in acute lower extremity deep vein thrombosis

目的研究不同置管入路溶栓治疗急性下肢深静脉血栓形成(deep vein thrombosis,DVT)的应用效果。方法76例行导管接触性溶栓(catheter directed thrombolysis,CDT)的患者,按置管入路不同分为腘静脉组(P组)和膝下静脉组(C组),各38例。比较两组手术用时、透视时间、造影剂用量、溶栓时间、髂静脉支架植入率、溶栓前后下肢周径差、血栓清除分级、舒适度评分及并发症发生率。结果C组手术用时、透视时间、造影剂用量均高于P组,差异具有统计学意义(P<0.05)。两组溶栓时间、髂静脉支架置入率差异无统计学意义(P>0.05)。两组溶栓后较溶栓前下肢周径差均明显下降,差异均有统计学意义(P<0.05)。C组术后舒适度评分明显高于P组,差异有统计学意义(P<0.05)。两组血栓清除分级及并发症发生率差异无统计学意义(P>0.05)。结论两种置管入路治疗急性期DVT均有显著疗效,膝下静脉入路置管溶栓患者术后舒适度优于腘静脉入路,尤其对老年或者难以配合制动的患者应作为首选。

Objective To evaluate the effects of different approaches for catheter-directed thrombolysis in acute lower extremity deep vein thrombosis(DVT).Methods Based on different approaches,76 patients who did catheter-directed thrombolysis(CDT)are divided into two groups:popliteal group(group P,n=38)and calf group(group C,n.=38).We compared differences between the two groups in terms of surgical time,fluoroscopy time,volume of contrast agent,thrombolysis time,iliac vein stent implantation rate,lower limb circumference,thrombus clearance rate,comfort score and complication rate.Results There are significant differences in operation time,fluoroscopy time and volume of contrast agent(P<0.05).The value in group C are higher than those in group P.There is no significant difference in thrombolysis time and stent implantation rate between the two groups(P>0.05).After thrombolysis,the lower limb circumference is significantly reduced(P<0.05).The postoperative comfort score of group C is significantly higher than that in group P(P<0.05).There is no significant difference in thrombolysis clearance rate and complication rate between the two groups(P>0.05).Conclusion Both approaches are effective in the treatment of acute DVT.The calf approach is better,according to the postoperative comfort score,especially for elderly patients or patients who are difficult to cooperate with immobilize.