经导管局部溶栓治疗髂股静脉血栓:58例回顾性分析

Catheter-directed Regional Thrombolysis for Treatment of Iliofemoral Venous Thrombosis: A Retrospective Analysis of 58 Cases

目的 探讨经导管局部溶栓治疗髂 股静脉血栓的效果及临床应用中的有关问题。资料与方法 对 5 8例髂 股静脉血栓形成患者 (病程 <4周 4 5例 ,>4周 13例 ) ,采取经导管血栓局部灌注尿激酶 ,尿激酶先团注2 5 0 0 0 0U ,然后以 12 5 0 0 0～ 15 0 0 0 0U/h持续灌注。结果 全组溶栓治疗时间 4～ 5 6h ,平均 36h ,尿激酶用量75 0 0 0 0～ 72 5 0 0 0 0U ,平均 4 70 0 0 0 0U。阻塞段完全开通 (残存狭窄率 <30 % )者 30例 ,部分开通者 2 3例 ,无效 5例 ,有效率达 91.4 %。对残存狭窄率 >30 %的 2 3例 ,14例行经皮球囊血管成形术 (PTA)治疗 ,9例行PTA及内支架治疗。 6例溶栓前放置下腔静脉过滤器。本组无严重并发症及肺栓塞发生。结论 经导管血栓局部灌注尿激酶是治疗髂 股静脉血栓的安全、有效方法。

Objective To evaluate catheter-directed regional thrombolysis with urokinase in the treatment of iliofemoral venous thrombosis, to discuss its clinical application.Materials and Methods Fifty-eight patients with iliofemoral venous thrombosis received catheter-directed regional thrombosis by using continuous infusion of urokinase. The illness duration was below 4 weeks in 45 cases and over 4 weeks in 13 cases. After an initial bolus injection of 250 000 U, the urokinase infusion was kept at the rate of 125 000～150 000 U/h.Results The average urokinase dose was 4 700 000 U (750 000～7 250 000 U),with the infusing time of 4～56 hours (mean 36 hours). Of 58 patients, complete open of the obstructed segment with residual stenosis ratio <30% was obtained in 30 (51.7%), partial open in 23 (39.7%) and ineffective in 5 (8.6%). The total effective rate was 91.4%. For the 23 patients who showed the residual stenosis ratio >30%, PTA was carried out in 14, PTA with stent placement in 9. In 6 patients, an inferior vena cava filter was placed before thrombolytic therapy was begun. Neither serious complications nor clinically detectable pulmonary embolism occurred.Conclusion Catheter-directed regional thrombolysis with urokinase is effective and safe for the treatment of iliofemoral venous thrombosis. Systemic anticoagulant therapy with heparin after the procedure can enhance thrombolytic effect.