小腿深静脉入路AngioJet一站式血栓清除治疗全肢型急性下肢深静脉血栓形成患者的临床研究

Clinical study of AngioJet one-stop thrombectomy via deep lower leg vein approach in patients with acute lower limb deep vein thrombosis

目的探讨全肢型急性下肢深静脉血栓形成(deep venous thrombosis,DVT)患者经小腿深静脉入路行AngioJet一站式治疗的安全性、可行性和有效性。方法回顾性选取本院收治的23例全肢型下肢急性DVT患者,均通过患侧小腿深静脉入路行AngioJet一站式血栓清除治疗。观察手术技术成功率和一般情况,观察是否合并小腿穿刺点出血及其他器官因尿激酶应用导致继发性出血等并发症,并对患肢通畅情况进行随访。比较手术前后谷草转氨酶、谷丙转氨酶、血肌酐、血尿素的指标水平。结果23例全肢型急性下肢DVT患者经小腿深静脉入路行AngioJet一站式血栓清除治疗均顺利完成,技术成功率100%。其中经腓静脉入路6例(26.1%),胫前静脉入路8例(34.8%),胫后静脉入路9例(39.1%)。术中吸栓量69~488 mL,平均(255±108)mL。21例(91.3%)一期开通,2例(8.7%)因血栓残留较多,予置管溶栓后二期开通。总体血栓清除率Ⅲ级14例(60.8%),Ⅱ级9例(39.2%)。联合髂静脉球囊扩张19例(82.6%),支架植入15例(65.2%,均为左下肢)。术后15例(65.2%)出现一过性血尿,术中、术后未出现小腿穿刺点出血及其他器官因尿激酶应用导致继发性出血等严重并发症。所有患者下肢肿胀症状均得到有效缓解。患者手术前后谷草转氨酶、谷丙转氨酶、血肌酐、血尿素差异均无统计学意义(P>0.05)。随访6~42个月,术后12个月髂股静脉一期通畅率为91.3%(21/23),深静脉血栓复发2例(8.7%)。1例在随访过程中出现轻度血栓后综合征,经延长抗凝和弹力袜压力治疗后好转。结论全肢型急性下肢DVT经小腿深静脉入路行AngioJet一站式治疗是安全、可行、有效的。

Objective To investigate the safety,feasibility and effectiveness of AngioJet one-stop treatment for acute lower extremity deep vein thrombosis(DVT)patients via deep lower leg vein approach.Methods Twenty-three patients with acute DVT of the whole limb type in our hospital were retrospectively selected.All patients underwent AngioJet one-stop thrombectomy through the deep vein approach of the affected lower leg.The success rate,general situation of the surgical technique,complications such as bleeding at the puncture point of the lower leg and secondary bleeding caused by urokinase application in other organs were observed,and the patency of the affected limb was followed up.The levels of glutamic oxaloacetic transaminase,glutamic pyruvic transaminase,blood creatinine and blood urea were compared before and after operation.Results Twenty-three patients with acute DVT of lower extremities were successfully treated with AngioJet one-stop thrombectomy via deep lower leg vein approach,with the technical success rate of 100%.There were 6 cases(26.1%)via peroneal vein,8 cases(34.8%)via anterior tibial vein,and 9 cases(39.1%)via posterior tibial vein.The intraoperative blood loss ranged from 69 to488 mL,with an average of(255±108)mL.Twenty-one cases(91.3%)were opened in the first stage,and 2 cases(8.7%)were opened in the second stage after catheter thrombolysis because of more thrombus residues.The overall thrombus clearance rate was gradeⅢin 14 cases(60.8%)and gradeⅡin 9 cases(39.2%).Nineteen cases(82.6%)were combined with balloon dilatation of iliac vein,and 15 cases(65.2%)were implanted with stent.Fifteen cases(65.2%)had transient hematuria after operation,and no serious complications such as leg puncture site bleeding and secondary bleeding caused by urokinase application in other organs occurred during and after operation.All patients'lower limb swelling symptoms were effectively relieved.There were no significant differences in glutamic oxaloacetic transaminase,glutamic pyruvic transaminase,blood creatinine and blood urea before and after operation(P>0.05).Follow up for 6 to 42 months showed that the primary patency rate of iliofemoral vein was 91.3%(21/23)12 months after operation,and deep vein thrombosis recurred in 2 cases(8.7%).One case developed mild post thrombotic syndrome during follow-up,which improved after prolonged anticoagulation and elastic stockings pressure treatment.Conclusion It is safe,feasible and effective to perform AngioJet one-stop treatment for acute DVT of whole limb type through deep vein of lower leg.