ObjectiveTo investigate the significance of catheter thrombolysis combined with one-stage iliac vein percutaneous transluminal angioplasty (or stent implantation) in the treatment of acute left lower extremity deep venous thrombosis secondary to Cockett syndrome.MethodsForty-one cases of Cockett syndrome complicated with acute left lower extremity deep vein thrombosis were retrospectively analyzed and summarized in our hospital from January 2016 to June 2019. Catheter directed thrombolysis was performed under the protection of filter, and percutaneous transluminal angioplasty or stent implantation was performed in the first stage of the iliac vein stenosis or occlusion after thrombolysis. Compared the circumference of upper and lower legs of 15 cm above and below patella of the healthy and affected limbs, before and after treatment, and analyzed the venous patency rate.ResultsThe average time of using thrombolytic catheter were (7±3) days, and the average dosage of urokinase was (358.32±69.38) ×104 U. A total of thirty-five Bard stents were implanted (35 cases), four cases underwent percutaneous transluminal angioplasty, and two cases gave up treatment. Before and after treatment, the circumference difference of the higher leg, the circumference difference of the lower leg, and the venous patency were significantly different before and after thrombolysis (P<0.01). The venous patency rate was 58%–75% in this group, and the average venous patency rate was (61±10)%. There was no severe bleeding complication occurred. Thirty-five patients were followed up for 3–26 months, the preservation rate of the valve was 82.86% (29/35), and the first patency rate of iliac vein was 100% (39/39). During the follow-up period, thrombosis recurred in one case of untreated iliac vein, and acute thrombosis in the right side of one case was caused by long iliac vein stent entering the inferior vena cava. No pulmonary embolism was found.ConclusionOn the basis of catheter thrombolysis, one stage removal of iliac vein obstruction in the treatment of acute left lower extremity deep venous thrombosis can relieve the clinical symptoms, reduce the recurrence rate of thrombosis, and reduce the occurrence of deep vein thrombosis syndrome after catheter thrombolysis.
Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on acute superior mesenteric vein thrombosis. Methods The treatment and therapeutic efficacy of 7 cases of acute superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under ultrasound guidance from August 2005 to April 2009 were analyzed. Results All the patients succeeded in portal vein catheterization and no bile leakage or abdominal bleeding occurred during the procedure. The clinical symptoms such as abdominal pain, abdominal distension， and passing bloody stool relieved were relieved and liquid diet began at postoperative of day 2-5. Emergency operation was done in one case and there was no intestinal fistula. The angiography after the operation showed that the majority of thrombosis were cleared and the blood of portal vein and superior mesenteric vein flowed smoothly. During the follow-up of 3 months to 3 years, all the patients’ status maintained well and no recurrence occurred. Conclusion Treatment of acute superior mesenteric vein thrombosis by percutaneous transhepatic portal vein thrombolysis is safe and effective.
目的:比较不同部位、不同方式深静脉置管的优缺点。方法:根据患者病情及能否配合操作,分别采用锁骨下静脉穿刺置管术、颈内静脉穿刺置管术、股静脉穿刺置管术并将三种术式的优缺点及所致的并发症进行比较。结果:276例深静脉置管术中(1) 经锁骨下置管者220例,占79.71%。其中术后感染2例,占0.91%;误入动脉2例,占0.91%;纵膈血肿1例,占0.45%;(2) 经颈内静脉置管者35例,占12.68%。其中术后感染3例,占1.40%;误入动脉者1例,占2.86%;气胸1例,占2.86%;术后导管脱落者1例,占2.86%;(3) 经股静脉置管者21例,占7.60%。其中术后感染5例,占23.8%;误入动脉者1例,占4.76%。结论:几种深静脉穿刺术中,尤以经锁骨下穿刺者并发症相对较少,是深静脉置管方式中的首选。
ObjectiveTo compare the differences of incidence rate and severity of postthrombotic syndrome (PTS) of patients with lower extremity deep venous thrombosis (DVT) treated by catherter-directed thrombolysis (CDT) or via peripheral vein thrombolysis (PVT).MethodsThe patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected. These patients were divided into CDT group and PVT group according to the different thrombolysis methods, and then the thrombolytic rates, thrombolytic complications, and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.ResultsA total of 137 cases of DVT were collected, 79 in the CDT group and 58 in the PVT group. There were no significant differences in the gender, age, course of disease, thrombus type, and other baseline data between the two groups (P>0.05). The thrombolytic rate of the CDT group was (78.6±16.3)% and PVT group was (27.3±12.1)%, the difference was significant (t=21.14, P<0.001). The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance (32.8% versus 21.5%, χ2=2.18, P=0.134). The 5-year follow up was completed in 116 cases, 74 patients from the CDT group and 42 patients from the PVT group respectively, the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group (35.1% versus 88.1%, χ2=30.28, P<0.001), and theseverity of PTS in the CDT group was milder than that in the PVT group too (Z=16.52,P<0.001).ConclusionFrom the results of this study, CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.
【摘要】 目的 探讨经腋静脉穿刺中央静脉置管后上肢深静脉血栓形成情况。 方法 2007年1月-2009年12月共收治60例需行中央静脉置管的患者，所有患者均通过腋静脉穿刺行中央静脉插管，并于拔除导管后行彩色多普勒超声检查了解双侧上肢深静脉血栓形成情况。将腋静脉穿刺侧上肢作为穿刺组，对侧上肢作为对照组，进行前瞻性对照研究，将两组上肢深静脉血栓发生率进行比较。 结果 60例患者中央静脉置管平均时间为（14.7±7.4） d，对照组彩色多普勒超声检查无深静脉血栓形成，穿刺组2例患者出现上肢深静脉血栓形成的症状，无肺栓塞发生，28例患者（47%）拔除的导管周围可见纤维蛋白套形成，经上肢彩色多普勒超声检查，5例患者（8.3%）腋静脉不完全栓塞，2例患者（3.3%）腋静脉完全栓塞。在中央静脉置管时间≤6 d的患者中，无上肢深静脉血栓形成；置管时间在7~14 d的患者中，2例（3.3%）腋静脉血栓形成；5例（8.3%）腋静脉血栓形成发生在置管时间≥15 d（Plt;0.01）。7例腋静脉血栓形成患者，经2~3次穿刺成功，平均穿刺时间（10±2.5） min，与无腋静脉血栓形成患者的平均穿刺所需时间（14±9）min比较，无统计学意义（Pgt;0.05）。 结论 经腋静脉穿刺中央静脉置管后上肢深静脉血栓形成的发生率为11.6%。【Abstract】 Objective To determine the frequency of central venous catheter-induced thrombosis of the axillary vein. Methods Sixty patients in a medical-surgical intensive care unit who required central venous catheterization via the axillary vein from January 2007 to December 2009 were selected. On catheter removal, color doppler ultrasonography examination was performed on all the patient. The incidence of deep vein thrombosis in catheterized arms was compared with that in uncatheterized arms. This study was designed by prospective controlled study. Results Catheters were inserted for a mean duration of (14.7±7.4) days. Sixty patients who underwent axillary vein cannulation, one patient had clinical signs of arm vein thrombosis, and no patient had clinical sign of pulmonary embolism. Fibrin sleeves that developed around the catheters were observed in 28 patients (47%). Five patients (8.3%) had phlebographic signs of partial axillary vein thrombosis:nonobstructive clots adherent to the vessel wall and (or) the catheter. Two patients (3.3%) had color doppler ultrasonography signs of complete axillary vein thrombosis. No thrombosis was observed in patients with catheterizations lasting ≤6 days, two cases were observed for duration of 7-14 days, and five cases were observed for duration of ≥15 days (Plt;0.01). In seven patients with axillary vein thrombosis, the vessel was cannulated with fewer than three puncture attempts, and the mean duration for catheter insertion (10±2.5) minutes didn’t differ much from that of patients with no axillary vein thrombosis (14±9) minutes. Conclusion The axillary vein catheterization is associated with 11.6% frequency of upper-extremity deep vein thrombosis.
ObjectiveTo investigate the clinical significance of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of patients with severe intra-abdominal infection (SIAI).MethodsThe clinical data of 7 patients with SIAI who underwent the debridement and drainage under ultrasound-guided puncture and catheterization combined with choledochoscopy from January 1, 2015 to December 31, 2017 in this hospital were retrospectively analyzed. The drainage sinus tracts were dilated for all patients. Then the choledochoscope was inserted into the infected areas along the dilated sinus tract. Finally, the drainage tube was placed under the guidance of the choledochoscope.ResultsOf the 7 patients, 6 patients were cured by this treatment, 1 case was converted to open surgery because the symptoms of illness were not improved. No relevant complications occurred. All patients were discharged after improvement of the disease. Currently, all cases were survival and no infection remained or recurred after follow-up to June 28, 2019.ConclusionsUltrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of SIAI is simple, safe, and effective. It could be used as an effective treatment for SIAI or alternative to open surgery.