Angiojet辅助导管接触性溶栓与单纯导管接触性溶栓治疗急性下肢深静脉血栓形成的中期临床对照研究

AngioJet-assisted catheter-directed thrombolysis versus catheter-directed thrombolysis alone in the treatment of acute deep venous thrombosis of lower extremity: a mid-term controlled clinical study

目的比较Angiojet机械血栓清除辅助导管接触性溶栓(ART+CDT)与单纯导管接触性溶栓(CDT)治疗急性下肢深静脉血栓形成的中期临床疗效。方法回顾性分析本中心2016年1月至2017年12月收治的91例急性下肢深静脉血栓形成患者,其中ART+CDT组30例、CDT组61例,比较两组尿激酶总剂量、手术总费用、溶栓时间、住院时间、治疗后患肢消肿率、血栓清除率、术后2年下肢静脉累积通畅率及2年和5年Villalta评分、血栓复发率及慢性静脉功能不全评估表。结果两组手术成功率均为100%,无死亡病例。两组在尿激酶总量、溶栓时间、手术总费用、住院天数、消肿率、静脉通畅率方面的差异均有统计学意义(均P<0.05)。术后2年及5年的血栓后综合征(PTS)发生率、血栓复发率、慢性静脉功能评分表及2年累积通畅率差异均无统计学意义(均P>0.05)。结论ART+CDT较单纯CDT早期疗效具有明显优势,ART+CDT及CDT中、长期随访均表现较低的PTS发生率、血栓复发率及较高的生活质量改善率,两组在下肢深静脉血栓介入治疗后的中期疗效没有显著差异。

Objective To compare the mid-term clinical effects of AngioJet rheolytic thrombectomy assisted catheter-directed thrombolysis(ART+CDT)with catheter-directed thrombolysis(CDT)in the treatment of acute deep venous thrombosis of lower extremities.Methods Ninety-one patients admitted to the Department from Jan 2016 to Dec 2017 were placed with inferior vena cava filters and divided into ART+CDT group(30 cases)and CDT group(61 cases).Total urokinase dosge,thrombolytic time,operative cost,length of hospital stay,detumescence rate,thrombus clearance rate,cumulative patency rate of lower limb veins,Villalta score at 2 years and 5 years,thrombosis recurrence rate and chronic venous insufficiency quality of life questionnaire were compared between the two groups.Results The success rate of surgery was 100%in both groups,there was no mortality.There were significant differences in the short-term postoperative outcomes between the two groups in terms of total dosage of urokinase,thrombolysis time,total cost of surgery,length of hospital stay,detumescence rate,venous patency scores before and after treatment,and venous patency rate(all P<0.05).For the mid-and long-term postoperative outcomes of 2 and 5 years,there were no significant differences in the incidence of PTS,recurrence rate of thrombus,chronic venous function scale,and cumulative patency rate at 2 years(all P>0.05).Conclusions ART+CDT has a significant advantage over CDT alone in terms of early efficacy and early reopening of blood flow in patients.Both ART+CDT and CDT have a low incidence of PTS and a low recurrence rate of thrombus in the mid-term follow-up,and both have satisfactory performance in the mid-and long-term efficacy of interventional treatment of deep venous thrombosis of lower limbs.