摘要
目的总结经三种入路导管溶栓联合髂静脉介入治疗急性下肢深静脉血栓形成的疗效。方法分析急性下肢深静脉血栓形成137例患者的临床资料，经小隐静脉置管溶栓107例，大隐静脉置管21例，胭静脉置管9例。对66例左髂静脉狭窄进行扩张，60例置入支架。结果经小隐静脉置管的肢体消肿率为82．3％±7．6％，经大隐静脉置管为81．6％±6．O％，经胭静脉置管为83．9％±6．1％，3种入路间两两比较，差异无统计学意义（P〉0．05）；溶栓率依次为63．5％±7．7％、66．9％±8．4％和66．1％±2．7％，3种入路间两两比较，差异无统计学意义（P〉0．05）；3种入路置管平均耗时依次为（20．8±1．1）min、（7．3±0．3）min和（15．7±0．6）min，经大隐静脉置管耗时较短（P〈0．05）。经小隐静脉置管有12例溶栓过程中并发切口出血，5例出现静脉炎，8例并发隐神经损伤；经胭静脉置管有2例并发术后胭窝血肿形成；经大隐静脉置管的并发症发生率较低（P〈0．05）。随访112例，随访时间7～22个月，平均（10．1±1．5）个月。97例无患肢肿胀。经下肢深静脉造影或彩色多普勒检查，89例静脉通畅，8例血栓复发。结论导管溶栓联合髂静脉介入是治疗急性下肢深静脉血栓形成的有效方法，经大隐静脉途径置管溶栓操作简单、术后并发症较少。
Objective To evaluate catheter-directed thromlysis （CDT） through three different approaches in combination with intervention for acute deep venous thrombosis （DVT） of the lower extremities. Methods In this study 137 acute DVT cases were enrolled. CDT was performed through small saphenous veins in 107 cases, through the great saphenous veins in 21 and through popliteal veins in 9. Iliac vein balloon dilation was performed in 66 cases, and stents were placed in 60 cases. Results The limb edema reduction rates between small saphenous vein group and great saphenous vein group and popliteal vein group were of no significant difference （82. 3% ±7.6% vs 81.6% ±6. 0% vs 83.9% ±6. 1%, P 〉 0. 05）. The difference of rates of thrombolysis （63.5% ± 7. 7% vs 66. 9% ± 8.4% vs 66. 1% ± 2. 7% ） between the 3 groups was not statistically significant （P 〉 0.05 ）. The mean time required for the cannulation was shorter in great saphenous vein group than the other two groups [ （7.3 ± 0. 3 ） rain vs （20. 8 ± 1. 1 ） rain and （ 15. 7 ±0. 6） rain, P 〈 0. 05 ]. There were 12 cases complicating incision bleeding during thrombolysis in small saphenous vein group, in this group there were 5 cases complicating phlebitis and 8 complicating saphenous nerve injury. The complication rates in great saphenous vein group was lower （P 〈 0.05）. Follow-up made in 112 cases for 3 -25 months. There were 97 cases without limb edema. While test by venography or color Doppler, 89 cases showed venous patency and rethrombosis developed in 8 cases. Conclusions Catheter-directed thrombolysis with iliac venous intervention was an effective method for the treatment of acute deep venous thrombosis. CDT through great saphenous vein is easier with less complications.
出处
《中华普通外科杂志》
CSCD
北大核心
2012年第3期193-196,共4页
Chinese Journal of General Surgery
基金
苏州市科技局应用基础研究计划基金资助项目（YJS0924）
