经皮机械血栓清除术治疗下腔静脉血栓形成的临床效果

Clinical effects of percutaneous mechanical thrombectomy in the treatment of inferior vena cava thrombosis

目的探讨经皮机械血栓清除术(PMT)治疗下腔静脉血栓形成的中长期临床效果。方法回顾性队列研究。纳入2018年1月—2021年10月北京积水潭医院45例下腔静脉滤器置入后合并下腔静脉血栓形成患者的临床资料。其中,男25例、女20例,年龄25~78(49.5±14.0)岁。按照治疗方法不同分组:采用PMT手术24例为PMT组,单纯抗凝治疗21例为抗凝组。观察指标:(1)观察PMT术中下腔静脉血栓清除效果。(2)比较2组患者下腔静脉管壁增厚、参考直径、最小直径及下腔静脉狭窄率。(3)比较2组患者的Villalta评分和静脉血栓后综合征的发生率。(4)分析Villalta评分和下腔静脉狭窄率的相关性。结果45例患者的下腔静脉滤器均成功回收,随访194~658 d,无下肢深静脉血栓形成或下腔静脉血栓形成复发。(1)PMT手术均获成功,下腔静脉血栓清除效果达到Ⅲ级4例、Ⅱ级20例。(2)2组患者年龄、性别、体质量指数、滤器留置时间和随访时间比较,差异均无统计学意义(P值均>0.05)。PMT组和抗凝组患者下腔静脉管壁增厚分别占67%(16/24)、86%(18/21),参考直径分别为(16.1±2.1)、(15.8±3.4)mm,差异均无统计学意义(χ2=2.20、t=0.33,P值均>0.05);最小直径分别为13.1(10.2,15.3)mm和10.2(0,13.5)mm,下腔静脉狭窄率分别为18.5%(10.2%,32.4%)和32.2%(18.5%,100.0%),差异均有统计学意义(Z=2.28、2.60,P值均<0.05)。(3)PMT组和抗凝组Villalta评分分别为3.0(2.0,4.0)和4(2.5,8.5)分,差异有统计学意义(Z=2.00,P=0.045),静脉血栓后综合征发生率分别为25%(6/24)和43%(9/21),差异无统计学意义(χ2=1.61,P=0.205)。(4)Villalta评分和下腔静脉狭窄率呈中等程度相关(rs=0.34,P=0.012)。结论相对于单纯的抗凝治疗,采用PMT治疗下腔静脉血栓形成,能减少患者的下腔静脉狭窄、降低静脉功能评分,改善患者的中长期生活质量。

Objective To evaluate the mid-and long-term clinical effects of percutaneous mechanical thrombectomy(PMT)in the treatment of inferior vena cava thrombosis(IVCT).Methods A retrospective cohort study was conducted.A total of 45 patients with inferior vena cava filter implantation and IVCT treated by PMT or anticoagulation in Beijing Jishuitan Hospital from January 2018 to October 2021 were included in this study.The patients included 25 males and 20 females aged 25-78(49.5±14.0)years.They were divided into two groups in accordance with treatment methods:24 cases in the PMT group and 21 cases in the anticoagulation group.Observation indicators included the following:(1)The thrombectomy effect of PMT in IVCT was observed.(2)The morphological changes in the inferior vena cava in the two groups,including the vascular wall thickening,reference diameter,minimum diameter,and stenosis rate of the inferior vena cava.(3)The Villalta score and incidence of post-thrombosis syndrome(PTS)were compared between the two groups.(4)The correlation between the Villalta score and the stenosis rate of the inferior vena cava were analyzed.Results Inferior vena cava filters were all successfully removed from 45 patients.Follow-up for 194-658 days showed that deep vein thrombosis or IVCT did not recur.(1)The PMT operations were successful,and IVCT clearance reached gradeⅢin 4 cases,and gradeⅡin 20 cases.(2)No significant difference was found between the two groups in terms of age,sex,body mass index,filter implantation time,and follow-up time(all P values>0.05).The vascular wall thickening of the inferior vena cava was 67%(16/24)and 86%(18/21),the reference diameters was(16.1±2.1)mm and(15.8±3.4)mm respectively in the two groups without significant differences(χ2=2.20,t=0.33;all P values>0.05).In the PMT and anticoagulation groups,the minimum diameters of the inferior vena cava were 13.1(10.2,15.3)and 10.2(0,13.5)mm,respectively,and the stenosis rates of the inferior vena cava were 18.5(10.1,32.4)%and 32.2(18.5,100.0)%,respectively,with statistically significant differences(Z=2.28,2.60;all P values<0.05).(3)In the PMT and anticoagulation groups,the Villalta scores were 3.0(2.0,4.0)and 4.0(2.5,8.5),respectively,with statistically significant differences(Z=2.00,P=0.045),and the incidences of PTS were 25%(6/24)and 43%(9/21),respectively,without significant differences(χ2=1.61,P=0.205).(4)The Villalta score was moderately correlated with the stenosis rate of the inferior vena cava(rs=0.34,P=0.012).Conclusion Compared with anticoagulation therapy,PMT for IVCT can reduce the stenosis of the inferior vena cava,the patient's Villalta score,and improve the patient's quality of life in the mid-and long-term.