下肢深静脉血栓形成的AngioJet机械吸栓与置管溶栓的对比研究

Mechanical thrombectomy with AngioJet compared with catheter-directed thrombolysis for treatment of lower extremity deep venous thrombosis

目的 比较机械吸栓与置管溶栓对于下肢深静脉血栓形成(DVT)的治疗效果.方法 回顾性分析2013年12月至2015年12月在我中心进行治疗的48例髂股深静脉血栓形成患者的临床资料.48例患者分别采用AngioJet机械吸栓(PMT)治疗(PMT组,24例)与置管溶栓(CDT)治疗(CDT组,24例).结果 PMT组Ⅲ级完全溶解20例(83.3％),Ⅱ级3例(12.5％)及Ⅰ级1例(4.2％);CDT组Ⅲ级完全溶解19例(79.1％),Ⅱ级4例(16.7％)及Ⅰ级1例(4.2％).两组溶栓结果比较差异无统计学意义(P=0.919).PMT组与CDT组临床改善结果相比较,其差异无统计学意义(21例比18例,P=0.461).PMT组溶栓时间明显短于CDT组[(0.25±0.11)h比(45.68±8.25)h,P＜0.001],且尿激酶平均用量也少于CDT组[(16.7±3.20)万U比(144±20.37)万U,P＜0.001].两组均未发生严重并发症.3例患者出现穿刺点周围少量皮下淤血斑,CDT组中1例出现溶栓导管感染,1例出现血小板降低.CDT组溶栓后患、健肢大、小腿平均周径差减小大于PMT组,但两组比较差异无统计学意义[(4.98±3.38)cm vs (4.11±1.71)cm,P=0.424;(4.52±2.14)cm vs(3.72±1.25)cm,P=0.272]].结论 与CDT治疗相比,PMT加支架植入术治疗髂股深静脉血栓形成具有相似的疗效,但是其具有治疗时间短、溶栓药物用量低等优点.

Objective To compare the treatment outcomes in patients with lower extremity deep venous thrombosis (DVT) who underwent either catheter-directed thrombolysis (CDT) or percutaneous mechanical thrombectomy (PMT) intervention.Methods A retrospective analysis of clinical records of all patients with lower extremity DVT (n=48) in our center from December 2013 to December 2015 was undertook.All patients underwent PMT treatment with AngioJet (PMT group,n=24) or CDT treatment (CDT group,n=24).Results In PMT group,complete thrombolysis was found in 20 cases (83.3％) with grade Ⅲ,3withgradelⅡ (12.5％) and l with grade Ⅰ (4.2％),respectively.And in CDT group,itwasl9 (79.1％),4 (16.7％) and 1 (4.2％),respectively.There were no significant differences of the thrombolysis outcomes between two groups (P=0.919).No significant differences of the clinical symptomatic improvement were found between two groups (21 vs.18,P=0.461).The procedural time was shorter in the PMT group (0.25±0.11 h) compared with CDT group [(45.68±8.25) h,P＜0.001].Urokinase dose was lower in the PMT group than CDT group [(16.7±3.20) million units vs.(144±20.37) million units,P＜0.001].There were no major complications in the both groups.Subcutaneous congestion around puncture site,catheter infection and blood platelet reduction occurred in 3,1 and 1 patient,respectively.The thigh and calf circumferences of CDT group decreased more than PMT group,but with no significant statistical differences [(4.98±3.38)cm vs.(4.11±1.71) cm,P=0.424;(4.52±2.14) cm vs.(3.72±1.25) cm,P=0.272].Conclusion PMT with the AngioJet device for lower extremity DVT requires shorter procedure time and lower urokinase doses than conventional CDT,while providing the same results.