彩色多普勒超声在急性下肢深静脉血栓机械性清除治疗中的临床价值

Clinical value of color Doppler ultrasound in percutaneous mechanical thrombectomy of acute deep venous thrombosis of lower extremity

目的 探讨彩色多普勒超声在急性下肢深静脉血栓(DVT)经皮机械性血栓清除(PMT)治疗中的临床价值。方法 选取我院收治的急性DVT患者132例,分为超声引导PMT治疗者82例(超声组)和静脉造影监测PMT治疗者50例(造影组),均行下腔静脉滤器置入、PMT联合导管直接溶栓治疗,比较两组术后静脉通畅情况、患肢周径差、血生化指标、手术时间、并发症发生情况及疗效。结果 超声组、造影组术后静脉通畅率分别为(82.03±12.51)%、(77.67±14.36)%,两组比较差异无统计学意义。超声组平均手术时间少于造影组[(1.08±0.32)h vs.(2.36±0.25)h],术后血红蛋白含量高于造影组[(125.66±15.48)g/L vs.(91.53±11.73)g/L],并发症发生率低于造影组(12.2%vs. 26.0%),差异均有统计学意义(均P<0.05);两组患肢周径差、手术前后D-二聚体浓度、术前血红蛋白含量、Villalta评分及流行病学和经济研究-生活质量评分比较差异均无统计学意义。结论 彩色多普勒超声在引导急性DVT患者PMT治疗中具有安全、有效、手术时间短、并发症少等优势,在术后可准确评估其疗效,具有重要的临床价值。

Objective To explore the clinical value of color Doppler ultrasound in percutaneous mechanical thrombectomy(PMT)of acute deep venous thrombosis of lower extremity(DVT).Methods Totally 132 patients with acute DVT admitted to our hospital were selected and divided into 82 cases treated by ultrasound guided PMT(ultrasound group)and 50 cases treated by venography monitored PMT(venography group).All patients were received inferior vena cava filter insertion and PMT combined with catheter thrombolysis.Venous patency,limb circumference difference,blood biochemical indicators,operation time,complications and efficacy were compared between two groups after treatment.Results The venous patency rates of ultrasound group and venography group were(82.03±12.51)%,(77.67±14.36)%,respectively,there was no significant difference between the two groups.Operation time in ultrasound group was less than that in venography group[(1.08±0.32)h vs.(2.36±0.25)h],the content of hemoglobin in ultrasound group was higher than that in venography group[(125.66±15.48)g/L vs.(91.53±11.73)g/L],the incidence of complications in ultrasound group was lower than that in venography group(12.2%vs.26.0%),and the differences were statistically significant(all P<0.05).There were no significant differences in limb circumference difference,D-dimer concentration before and after operation,content of hemoglobin before operation,Villalta score and epidemiological and economic studies-the quality of life score after operation.Conclusion Color Doppler ultrasound is safe and effective in guiding PMT treatment in patients with acute DVT,which has the advantages of short operation time and few complications.Color Doppler ultrasound can accurately evaluate its efficacy after operation,which has important clinical value.