置管溶栓治疗恶性肿瘤患者急性下肢深静脉血栓的疗效分析

Evaluation of catheter-directed thrombolysis through popliteal vein for the treatment of tumor-induced acute deep venous thrombosis

目的:探讨Unifuse导管接触溶栓治疗恶性肿瘤患者急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的临床效果。方法:将我院2014年1月至2016年8月经多普勒超声确诊的16例恶性肿瘤合并急性下肢DVT患者为研究对象,采用下腔静脉滤器置入加置管溶栓,应用尿激酶高压注射器冲击溶栓剂量为30万U,微量泵溶栓(236±42.34)万U,以及球囊扩张等方法,以术前、后的健侧、患肢周径差、静脉通畅度评价疗效。结果:治疗后,膝上周径减少(8.6±0.9)cm,vs(2.7±0.6)cm,膝下周径减少(3.5±0.3)cm,vs(1.3±0.5)cm。术前、后静脉通畅度评分显著改善(8.3±1.1 vs 2.0±0.6,P<0.05),治疗过程中无严重并发症。结论:急性下肢深静脉血栓可能是恶性肿瘤病变的一种局部临床表现,要重视其合并恶性肿瘤的可能,减少漏诊率。应用尿激酶经腘静脉置管溶栓治疗急性下肢深静脉血栓形成患者具有见效快、治愈率高等特点,效果显著,症状缓解明显,能够迅速恢复深静脉血流,值得临床推广。

Objective: To discuss the clinical effect of catheter-directed thrombolysis( CDT) using Unifuse cathter for the treatment of tumor-induced acute deep venous thrombosis( DVT). Methods: From January 2014 to August 2016,16 cases of tumor-induced acute DVT of lower extremity,which were diagnosed by Doppler ultrasound,were included. The patients received a treatment of implantation of inferior vena cava filter( IVF) and a following CDT,with an impulse urokinase administration dose using urokinase by high-pressure injector of 300 000 U and a maintance dose using micro bump of( 2 360 000 ± 423 400) U,associated with balloon angioplasty when necessary. The curative effect was assessed by the difference between preoperational and postoperational circumference of the affected limbs,as well as the difference between the preoperational and postoperational venous patency score. Results: Both the circumference above the knee[preoperational( 8. 6 ± 0. 9) cm vs postoperational( 2. 7 ± 0. 6) cm] and below the knee[preoperational( 3. 5 ± 0. 3) cm vs postoperational( 1. 3 ± 0. 5) cm] decreased evidently after the treatment. The venous patency score was also improved significantly( preoperational 8. 3 ± 1. 1 vs postoperational 2. 0 ± 0. 6,P< 0. 05). No severe complication was observed during the treatment. Conclusion: As DVT might represent the metastasis of maglinant tumors,clinical practitioners should pay additional attention to the possible commorbity of cancers to reduce unnecessary missed diagnosis. Treating acute mixed DVT of the left lower extremity by urokinase CDT through popliteal vein is an effective therapy with rapid action profile and high cure rate,helping relieve the symptoms and restore the venous function quickly,and therefore worth spreading during clinical practice.