手术后继发下肢深静脉血栓形成患者的治疗探索

A comparative study in the treatment of postoperative low extremity deep vein thrombosis

目的评估手术后继发下肢深静脉血栓形成患者溶栓治疗的出血风险,探索相对高出血风险的术后深静脉血栓形成患者更安全有效的治疗方法。方法选取2015年1月至2018年1月青岛市市立医院血管外科收治的48例手术后继发下肢深静脉血栓形成患者,PMT组27例,给予AngioJet吸栓或AngioJet吸栓+置管溶栓;CDT组21例,给予单纯置管溶栓。比较两组患者血栓清除效果及后期随访效果。结果PMT组的血栓清除率(90.21±17.28)%明显高于CDT组(75.65±27.59)%,尿激酶用量显著降低[(105.45±126.34)万U比(345.87±118.38)万U],住院时间[(6.72±1.88)d比(8.82±2.97)d]和卧床时间[(2.90±2.71)d比(5.40±2.06)d]也明显缩短,两组均无主要出血并发症的发生,次要出血并发症发生率CDT组较高,但差异无显著性。后期随访,PMT组患者12和24个月PTS的Villalta评分优于CDT组。结论术后时间>1周的下肢深静脉血栓形成患者,AngioJet机械吸栓和单纯置管溶栓均是安全有效的治疗方法,出血风险低。结合AngioJet机械吸栓的方案,可显著减少溶栓药物的使用剂量,血栓清除率高,并能明显缩短患者的住院和卧床制动时间,后期随访Villalta评分低,降低了深静脉血栓后综合征的发病风险。

Objective To estimate the risk of bleeding after thrombolytic therapy in patients with secondary deep venous thrombosis,in order to find a better therapy for higher bleeding risk postoperative patients.Methods 48 patients diagnosed postoperative DVT were divided into PMT group included 27 patients and CDT group included 21 patients.The PMT group was treated by PMT or PMT+CDT,the CDT group given thrombolysis only directed by catheterization.The effects of thrombus removal and later follow-up effects in the two groups were compared.Results Thrombus degradation was obviously better in PMT group compared with the CDT group[(90.21±17.28)%vs(75.65±27.59)%].Lower dosage of urokinase[(105.45±126.34)WU vs(345.87±118.38)WU]and shorter hospital stays[(6.72±1.88)d vs(8.82±2.97)d],less time in bed[(2.90±2.71)d vs(5.40±2.06)d]was also detected in PMT group patients.There is nonmajor bleeding occurred in both groups.Nonmajor bleeding was higher in PMT group,but they did not achieve statistical significance(P>0.05).In later follow-up,PTS Villalta scores of 12 and 24 months in PMT were better than CDT.Conclusion Both PMT and single CDT were both effective and safety methods in treating postoperative DVT more than one week,associated low bleeding risk,however the strategy combined PMT had the advantage in low dosage of urokinase using,better thrombus eliminating,and reducing the hospital stays and time in bed.Villalta score was lower in PMT-group,connected with lower risk of PTS morbidity.