导管吸栓在急性下肢深静脉血栓形成患者导管接触性溶栓术后的应用

Application of catheter aspiration technique in patients with acute lower extremity deep venous thrombosis after catheter-directed thrombolysis

目的探讨导管吸栓技术治疗急性下肢深静脉血栓形成(deep venous thrombosis,DVT)患者行CDT后残留血栓性静脉闭塞的可行性。方法分析2014年1月至2018年12月海南省人民医院收治114例CDT治疗后仍残留血栓性静脉闭塞的急性下肢DVT患者临床资料,患者根据是否采用导管吸栓技术抽吸残余血栓分为吸栓组(64例)和观察组(50例),通过比较两组患者症状和生活质量评分分析导管吸栓的治疗效果。结果导管吸栓技术成功率100%,吸栓有效率为90.6%,平均抽出血量(606.5±104.7)ml,无血管损伤、败血症、失血性休克等并发症发生。吸栓组术后12个月瓣膜反流发生率低于观察组(35.9%vs 58.0%,P=0.019)。吸栓组术后6、12、18个月深静脉血栓形成后综合征发生率与观察组比较差异无统计学意义(P>0.05),术后24个月发生率低于观察组(31.7%vs 52.0%,P=0.031)。两组术后6个月生活质量比较差异无统计学意义(P>0.05),吸栓组术后12、18、24个月的生活质量均优于观察组(P<0.05)。结论导管吸栓技术治疗急性下肢DVT患者行CDT后残留血栓性静脉闭塞安全、可靠,技术成功率高,近中期疗效较好。

Objective To explore the feasibility of catheter aspiration technique in patients with acute deep venous thrombosis(DVT)after CDT.Methods The clinical data of 114 patients with acute lower extremity DVT with residual thrombus after CDT from January 2014 to December 2018 in Hainan General Hospital were analyzed.Patients were divided into suction group(64 cases)and observation group(50 cases)according to whether the catheter aspiration technique was used for residual thrombus.The treatment effect of catheter aspiration was analyzed by comparing the symptoms and quality of life between the two groups.Results The technical success rate of catheter aspiration technique was 100%,and the effective rate was 90.6%.The average bleeding volume was(606.5±104.7)ml in the suction group.There were no vascular injury,sepsis or hemorrhagic shock occurred.The incidence of valve regurgitation in the suction group was lower than that in the control group at 12 months after surgery(35.9%vs 58.0%,P=0.019).There were no significant differences in the incidence of post-thrombotic syndrome(PTS)at 6,12,and 18 months after surgery between the two groups(P>0.05).The incidence of PTS in the suction group was lower than that in the control group at 24 months after surgery(31.7%vs 52.0%,P=0.031).There was no significant difference in the quality of life between the two groups at 6 months after surgery(P>0.05).However,the quality of life in the suction group was better than that of the control group at 12,18,and 24 months after surgery(P<0.05).Conclusion Catheter aspiration technique for acute lower extremity DVT patients with residual thrombus after CDT is safe and reliable,which has a high technical success rate and good short and mid-term efficacy.