下腔静脉滤器植入、溶栓、手术治疗下肢深静脉血栓形成

Treatment of lower extremity deep venous thrombosis with IVC filter placement ,embolectomy and thrombolytic therapy

目的 探讨下肢深静脉血栓形成 (DVT)的有效治疗方法。方法 回顾性分析近 9年来治疗的 2 11例下肢DVT的临床资料。直接患肢深静脉溶栓 179例 ,其中下腔静脉滤器植入 2 9例(临时性滤器 5例 ,永久性滤器 2 4例 ) ;下腔静脉滤器植入并手术 (取栓、球囊扩张、支架植入、髂静脉成型 ) 3 2例 ,其中植入临时性滤器 6例 ,永久性滤器 2 6例。结果 14 6例 (68.7% )随访 3～ 10 8个月 ,平均 54个月。 61只下腔静脉滤器均展开良好 ,有 1例临时滤器移位至下腔静脉近心端 ,其他无移位。临时滤器体内置放 2～ 4周取出。 1例永久性滤器植入 14个月后滤器中血栓形成。溶栓组显效 87例 ,有效 86例 ,无效 6例。手术组显效 2 8例 ,有效 3例 ,无效 1例。手术组显效率显著高于溶栓组 (P <0 .0 5) ,但总有效率差别无显著性 (P >0 .0 5)。结论 下腔静脉滤器植入能有效预防肺动脉栓塞 ,但应严格掌握适应证。

ObjectiveTo investigate the feasible and effective means for the lower extremity deep ve nous thrombosis(DVT).Methods The clincal data of 211cases of l ower extremity DVT treated in recent 9 years were analysed retrospectively .Antegrade infusion of high -dose urokinase was performed via the dorsalis pedi s vein of the involved lower limb in 179 patients.Of the 179 patients vena cava filters(VCF) was placed in 29 patients,including Tempofilter II VCF in 5pa tients, VenaTech TM LP VCF in 24patients.Other 32 cases underwent embol ectomy after IVC filter placement(Tempofilter II was placed in 6patients, VenaT echTM LP was placed in 26patients). Results 146 patients were followed up for 3-108 months with averge 54months .A total of 61 IVC filters w ere successfully expanded ,but 1 Tempofilter II VCF was migrated to proximal end of IVC.Tempofilter II VCF was taked out 2-4 week after the IVC filt er placement . VenaTechTM LP occlusion in one case 14 months after the IVC fil ter placement.In thrombolytic group,87were cured,86 improved,6 ineffective. In operative group, 28were cured,3 improved,1 ineffective . The cured rate in op erative group was better than that in thrombolytic group(P<0.05),but the tot al effective rate was similar in both groups.Conclusions Vena cava filters placement can effectively prevent the formation of pu lmonary embolism, but the indication should be strict.Combination of surgery wit h other therapy is effective in improving the results and preventing the se quela of lower extremity DVT.