导管溶栓术在下肢深静脉血栓治疗中的应用效果

Application effect of catheter directed thrombolysis on the treatment of lower limb deep vein thrombosis

目的探讨导管溶栓术在下肢深静脉血栓(DVT)治疗中的应用效果。方法收集2016年1月至2019年12月首都医科大学附属北京潞河医院普外科收治的71例行静脉导管溶栓术下肢DVT患者的临床资料进行回顾性分析。其中5例行髂静脉球囊扩张支架置入术,52例于术中行长鞘管负压吸栓术。术后通过观察下肢周径变化、患肢消肿率及静脉通畅率,探讨导管溶栓术的疗效。结果71例患者中,65例(91.5%)术后造影提示静脉通畅改善,5例髂静脉重度狭窄于溶栓后行球囊扩张及支架置入术,1例静脉闭塞未能开通。71例患者下肢周径均有所改善。71条患肢溶栓后膝上、膝下15 cm周径均较治疗前减小,差异均有统计学意义[(51.6±0.8)cm比(54.4±1.3)cm、(37.0±0.8)cm比(39.1±0.9)cm](t=8.190,P=0.029;t=7.580,P=0.038)。患肢消肿率为(74±9)%,静脉通畅率为(73±8)%。结论导管溶栓术在下肢DVT治疗方面疗效肯定。

Objective To explore the application effect of catheter directed thrombolysis(CDT)on the treatment of lower limb deep vein thrombosis(DVT).Methods From January 2016 to December 2019,clinical data of 71 patients with lower limb DVT who underwent venous CDT in the Department of General Surgery,Beijing Luhe Hospital,Capital Medical University were selected for retrospective analysis.Five patients underwent balloon dilatation stent implantation of the iliac vein,and 52 patients underwent long sheath negative pressure aspiration.After the operation,the effect of catheter thrombolysis was discussed by observing the changes in the circumference of the lower limbs,and the detumescence rate of the affected limbs and venous patency rate.Results Postoperative angiography showed venous patency in 65 cases(91.5%).Five cases with severe stenosis underwent balloon dilation and stent implantation.One case of venous occlusion failed to open,and 71 cases of lower limb circumference improved.After thrombolytic therapy,the circumference of 15 cm above and below the knee of 71 limbs decreased compared with those before treatment[(51.6±0.8)cm vs(54.4±1.3)cm,(37.0±0.8)cm vs(39.1±0.9)cm](t=8.190,P=0.029;t=7.580,P=0.038).The detumescence rate of the affected limb was(74±9)%,and the patency rate of vein was(73±8)%.Conclusion CDT is effective in the treatment of lower limb DVT.