机械性血栓清除术与单纯经皮导管接触性溶栓术治疗急性下肢深静脉血栓合并髂静脉压迫综合征的临床疗效

Clinical efficacy of mechanical thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep vein thrombosis complicated with iliac vein compression syndrome

目的探讨机械性血栓清除术(PMT)与单纯经皮导管接触性溶栓术(CDT)治疗急性下肢深静脉血栓(DVT)合并髂静脉压迫综合征(IVCS)的临床疗效。方法收集2019年3月至2020年8月西南医科大学附属医院收治的80例急性下肢DVT合并IVCS患者的临床资料,根据治疗方法的不同将患者分为PMT组(n=42,给予机械性血栓清除术)和CDT组(n=38,给予单纯经皮导管接触性溶栓术)。比较两组患者血栓清除率,手术前后大、小腿周径差,D-二聚体水平、Villalta评分。结果PMT组患者尿激酶用量少于CDT组患者,溶栓治疗时间、住院时间均短于CDT组患者,差异均有统计学意义(P<0.05)。PMT组患者血栓清除率高于CDT组患者,Villalta评分低于CDT组患者,差异均有统计学意义(P<0.05)。术后,两组患者大、小腿周径差均小于本组术前,差异均有统计学意义(P<0.05);两组患者大、小腿周径差比较,差异均无统计学意义(P>0.05)。PMT组患者D-二聚体高峰持续时间短,下降时间早于CDT组,且下降趋势快。结论PMT治疗急性下肢DVT合并IVCS患者的血栓清除率较高,尿激酶用量少,溶栓治疗时间及住院时间均较短,可减少大、小腿周径差,短中期疗效确切,值得临床进一步推广应用。

Objective To investigate the clinical efficacy of percutaneous mechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)in the treatment of acute lower extremity deep vein thrombosis(DVT)complicated with iliac vein compression syndrome(IVCS).Method The clinical data of 80 patients with acute lower extremity DVT complicated with IVCS admitted to the Affiliated Hospital of Southwest Medical University from March 2019 to August 2020 were collected.The patients were divided into PMT group(n=42,given mechanical thrombectomy)and CDT group(n=38,given simple percutaneous catheter-directed thrombolysis)according to different treatment methods.The thrombus clearance rate,the difference in the circumference of the thigh and calf before and after the operation,the D-dimer level,and the Villalta score were compared between the two groups.Result The dosage of urokinase in the PMT group was less than that in the CDT group,the thrombolytic treatment time and hospital stay time were shorter than those in the CDT group,the differences were statistically significant(P<0.05).The thrombus clearance rate in the PMT group was higher than that in the CDT group,the Villalta score was lower than that in the CDT group,the differences were statistically significant(P<0.05).After the operation,the difference in the circumference of the thigh and calf between the two groups was smaller than that before the operation,the difference was statistically significant(P<0.05).However,there was no statistically significant difference between the two groups in the difference of the circumference of the thigh and calf(P>0.05).The peak duration of D-dimer in the PMT group was shorter,the decline time was earlier than that in the CDT group,and the declining trend was rapid.Conclusion PMT in the treatment of acute lower extremity DVT patients combined with IVCS has a higher thrombus clearance rate,while the dosage of urokinase is less,and the thrombolytic treatment time and hospitalization time are shorter.This method could reduce the difference in the circumference of the thigh and calf,and the curative effect is definite in the short-to-medium term,which is worthy of further clinical application.