腔内血栓清除术治疗下肢深静脉血栓形成的应用分析

Analysis of application of endovascular thrombectomy in the deep venous thrombosis of lower extremities

目的分析腔内血栓清除术对下肢深静脉血栓形成(deep venous thrombosis,DVT)患者的利弊。方法对2017年6月至2019年6月在首都医科大学宣武医院收治的107例符合纳入标准的DVT患者进行回顾性队列研究,按主要治疗方式分为抗凝组(单纯抗凝,67例)和手术组(行腔内血栓清除术,40例),随访比较术后2年血栓形成后综合征(post-thrombotic syndrome,PTS)和并发症的情况。结果患者术后随访690~720 d,中位随访时间699 d,患者的肺栓塞和股青肿等均得到缓解,无静脉血栓栓塞症相关死亡。29例患者罹患PTS,其中抗凝有23例(34.3%),手术组6例(15.0%),差异有统计学意义(P=0.030)。抗凝组的中-重度PTS患者比例显著高于手术组(P=0.018)。相比于抗凝组,手术组患者免于发生PTS风险更加长久(P=0.021)。抗凝组出现1例(1.5%)治疗相关并发症,手术组出现7例(17.5%),差异有统计学意义(P=0.004),其中手术组的主要并发症为一过性急性肾损伤。结论腔内血栓清除术能降低下肢DVT患者术后2年的PTS发病率及发病程度,并推迟PTS的发病时间,但可能会提高并发症的发生风险。

Objective To analyze the pros and cons of endovascular thrombectomy for patients with deep venous thrombosis(DVT)of lower extremities.Methods A retrospective cohort study was conducted on 107 DVT patients who met the inclusion criteria and were treated in Xuanwu Hospital of Capital Medical University from June 2017 to June 2019.They were divided into anticoagulation group(anticoagulation alone,67 cases)and operation group(endovascular thrombectomy,40 cases)according to the main treatment.Post-thrombotic syndrome(PTS)and complications were compared during the 2-year follow-up period.Results The patients were followed up for 690-720 days after operation,with a median time of 699 days.All pulmonary embolism and femoral bruise were relieved,and there was no venous thromboembolism-related death.Twenty-nine patients suffered from PTS,including 23 cases(34.3%)in the anticoagulation group and 6 cases(15.0%)in the operation group,and the difference was statistically significant(P=0.030).The proportion of patients with moderate and severe PTS in the anticoagulation group was significantly higher than that in the operation group(P=0.018).Compared with the anticoagulation group,patients in the operation group were free from the risk of PTS for a longer period of time(P=0.021).There was 1 case(1.5%)of treatment-related complications in the anticoagulation group,and 7 cases(17.5%)in the operation group,the difference was statistically significant(P=0.004),and the main complication in the operation group was transient acute kidney injury.Conclusion Endovascular thrombectomy can reduce the incidence and severity of PTS and delay the onset of PTS in patients with DVT of lower extremities in the 2-year period after surgery,but it may increase the risk of complications.