临时滤器保护下深静脉血栓的介入治疗

Interventional therapy of lower extremity deep vein thrombosis under protection of temporary vena cava filter

目的 研究在临时滤器保护下 ,对深静脉血栓进行局部溶栓或并用机械取栓的临床应用价值。方法 32例下肢深静脉血栓病人用导管局部溶栓的方法治疗 ,其中 12例先使用水动力取栓导管系统治疗。并置入临时滤器预防肺动脉栓塞 ,共置入 34只 ,有 2例置入 2只。结果 溶栓有效率为 75 % ,其中 17例血栓完全溶解 (占 5 3% ) ,7例溶解 5 0 %～ 10 0 % (占 2 2 % )。溶栓时间 ,单纯溶栓平均 6 1.7h ,取栓加溶栓平均 30 .3h ,两者差异有非常显著性意义 (t=3.0 8,Ρ <0 .0 1)。治疗中未发生症状性肺动脉栓塞。结论 局部溶栓和机械性取栓结合 ,同时用临时滤器预防肺动脉栓塞 。

Objective To determine the usefulness and complication of interventional therapy of deep venous thrombosis (DVT) with local thrombolysis or a combination of mechanical thrombectomy and local thrombolysis under the protection of temporary vena cava filter,and to assess the efficacy of temporary vena cava filter.Methods Thirty-two patients with DVT were treated with catheter-directed local thrombolysis (n=20) or a combination of hydrodynamic thrombectomy and local thrombolysis (n=12) after insertion of a temporary caval filter.34 temporary caval filters were inserted and two cases received 2 filters.Results Successful recanalization was achieved in 75% of patients.A complete lysis was achieved in 17 cases (53%),and thrombolysis of 50%-100% in 7 cases (22%).The mean durations for local thrombolysis alone were 61.7 hours and for the combination of thrombolysis with hydrodynamic thrombectomy were 30.3 hours.There was a statistically significant difference between the two methods (t=3.08,P< 0.01).No clinical relevant pulmonary embolism occurred during the therapy procedure.Conclusion A combination of mechanical thrombectomy and local thrombolysis with the use of temporary vena cava filter provides a more safe method in the therapy of DVT.The insertion of a temporary caval filter is promising in the reduction of pulmonary embolism.