Catheter Directed Thrombolysis versus Mechanical Thrombectomy Combined with Catheter Directed Thrombolysis for Lower Extremity Deep Vein Thrombosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王沆 , 李春平 , 林隆辉 ,  韩涛

福建省立医院心脏血管外科（福州 350001）;

Corresponding author：

韩涛, Email: fjsxxwk@163.com

Keywords：

下肢深静脉血栓形成; 球囊扩张; 机械碎栓; 腔静脉滤器

DOI：

10.7507/1007-4848.20160071

Video：

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目的研究置管溶栓联合球囊扩张导管碎栓治疗下肢深静脉血栓形成（DVT）的疗效及安全性。方法回顾性分析2011年9月至2015年1月本院收治的82例急性下肢DVT患者的临床资料。将患者分成两组：A组行单纯经导管直接溶栓（CDT）治疗，共32例，其中男10例、女22例，平均年龄（56±15）岁；B组行CDT联合机械碎栓（球囊扩张导管碎栓）治疗，共50例，其中男18例、女32例，平均年龄（57±17）岁。比较2组治疗前后静脉通畅率、静脉通畅度评分、健侧和患侧下肢周径差，比较2组尿激酶用量及溶栓导管留置时间，以出血并发症、肺栓塞的发生率评价治疗的安全性。结果 2组共82例患者完成溶栓及碎栓疗程，B组较A组溶栓时间更短，A组平均9（7，12）d；B组平均5（4，7）d，2组差异有统计学意义（P<0.01）；B组较A组尿激酶用量更少，A组平均7.250（6.355，8.255）×10⁶ U，B组平均4.925（3.715，5.810）×10⁶ U，2组差异有统计学意义（P<0.01）；B组治疗后的静脉通畅度评分显著优于A组，A组65.0%（40.5%，86.5%），B组为100%（90%，100%），差异有统计学意义（P<0.01）。治疗后2组出血并发症发生率差异无统计学意义（P=0.0976）。2组患者随访时间3～18个月，A组随访率50.0%，B组随访率58.0%，均未发生肺动脉栓塞。结论在下腔静脉滤器保护下，CDT联合球囊扩张导管碎栓治疗急性下肢DVT较单纯CDT治疗，溶栓效果好、尿激酶用量少、不增加肺栓塞及出血发生率。

Citation： 王沆, 李春平, 林隆辉, 韩涛. Catheter Directed Thrombolysis versus Mechanical Thrombectomy Combined with Catheter Directed Thrombolysis for Lower Extremity Deep Vein Thrombosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(3): 307-310. doi: 10.7507/1007-4848.20160071 Copy

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1. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南. 中华普通外科杂志, 2008, 23(3): 235-238.
2. 中华医学会放射学分会介入学组. 下腔静脉滤器置入术和取出术规范的专家共识. 中华放射学杂志, 2011, 20(5): 297-300.
3. Porter JM, Moneta GL. Reporting standards in venous disease:an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg, 1995, 21(3): 635-645.
4. Kasirajan K, Gray B, Ouriel K. Percutaneous Angio Jet thrombectomy in the management of extensive deep venous thrombosis. J Vasc Interv Radiol, 12(2): 179-185.
5. Dasari TW, Pappy R, Hennebry TA. Pharmacomechanical thrombo-lysis of acute and chronic symptomatic deep vein thrombosis:a systematic review of literature. Angiology, 2012, 63(5): 138-145.
6. Kim HS,Ajanta P, Ben E, et al. Comparison of CDT Alone or with Percutaneous Rheolytic Thrombectomy for DVT. Cardiovasc Intervent Radiol, 2006, 29(3): 1003-1007.
7. Schmitz-Rode T, Janssens U, Schild HH, et al. Fragmentation of massive pulmonary embolism using a pigtail rotation catheter. Chest, 1998, 114(5): 1427-1436.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Catheter Directed Thrombolysis versus Mechanical Thrombectomy Combined with Catheter Directed Thrombolysis for Lower Extremity Deep Vein Thrombosis

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