AngioJet机械性血栓抽吸联合导管接触溶栓治疗急性下肢深静脉血栓形成效果观察

Angio Jet mechanical aspiration thrombectomy combined with catheter directed thrombolysis for acute deep venous thrombosis: observation of its curative effect

目的探讨经皮机械性血栓清除术(PMT)联合导管接触溶栓(CDT)治疗下肢深静脉血栓形成(DVT)的安全性和近期效果。方法回顾性分析2017年1月至2018年12月徐州医科大学附属医院收治的56例急性中央型、混合型下肢DVT患者临床资料。其中28例接受AngioJet机械性血栓抽吸联合CDT治疗(A组),28例接受单纯CDT治疗(B组)。比较两组患者治疗期间尿激酶总量、溶栓时间、住院时间、静脉通畅率,手术前后静脉通畅评分、D-二聚体、纤维蛋白原及并发症发生情况。结果两组患者手术均获成功。A组PMT后即刻血栓清除率>90%(Ⅲ级)14例,50%~90%(Ⅱ级)14例。A、B组患者术后静脉通畅评分分别为1.64±1.31、2.68±1.76,尿激酶用量分别为(234.29±97.69)万U、(420.71±86.92)万U,溶栓时间分别为(6.96±2.60) d、(12.07±3.02) d,住院时间分别为(13.64±5.49) d、(17.82±4.89) d,差异均有统计学意义(P<0.05),术后静脉通畅率分别为(82.58±13.77)%、(74.88±15.73)%,差异无统计学意义(P>0.05)。两组患者术前术后D-二聚体、纤维蛋白原差异均无统计学意义(P>0.05)。A组6例出现血红蛋白尿,2例出现轻度肝功能异常,经保守治疗后均好转,两组患者均未出现严重并发症。结论 AngioJet血栓抽吸联合CDT治疗急性中央型、混合型下肢DVT安全,近期疗效显著,有助于减少溶栓时间、住院时间、尿激酶用量,降低出血风险。

Objective To evaluate the safety and short-term efficacy of percutaneous mechanical thrombectomy(PMT) combined with catheter directed thrombolysis(CDT) in treating acute deep vein thrombosis(DVT) of lower extremity. Methods The clinical data of 56 patients with acute central type or mixed type DVT of lower extremity, who were admitted to the Affiliated Hospital of Xuzhou Medical University of China during the period from January 2017 to December 2018, were retrospectively analyzed. Of the 56 patients, 28 received AngioJet PMT combined with CDT(group A), and 28 received CDT only(group B). The total amount of urokinase used during the treatment, the duration of thrombolysis, the hospitalization days, the venous patency rate, the preoperative and postoperative venous patency scores, the D-dimer level, the fibrinogen level and the incidence of complications were compared between the two groups. Results Successful thrombectomy procedure was accomplished in all patients of both groups. In group A, the post-PMT instant thrombus clearance rate of grade Ⅲ(>90%) was achieved in 14 patients and grade Ⅱ(50%-90%) was achieved in 14 patients. In group A and group B, the postoperative venous patency scores were(1.64±1.31) points and(2.68±1.76) points respectively, the total used doses of urokinase were(234.29±97.69)×104 U and(420.71±86.92)×104 U respectively, the duration of thrombolysis was(6.96±2.60) days and(12.07±3.02) days respectively,the hospitalization days were(13.64±5.49) days and(17.82±4.89) days respectively, the differences in the above indexes between the two groups were statistically significant(P<0.05). In group A and group B, the postoperative venous patency rates were(82.58±13.77)% and(74.88±15.73)% respectively, the difference between the two groups was not statistically significant(P>0.05). No statistically significant differences in preoperative and postoperative levels of D-dimer and fibrinogen existed between the two groups(P >0.05). In group A, 6 patients developed hematoglobinuria and 2 patients developed mild hepatic dysfunction, which were improved after conservative treatment. No serious complications occurred in both groups. Conclusion For the treatment of acute central type or mixed type DVT of lower extremity, AngioJet PMT combined with CDT is clinically safe with remarkable short-term effect, it is helpful for reducing the duration of thrombolysis, the hospitalization days and the dosage of urokinase, and also for decreasing the risk of bleeding as well.