球囊扩张碎栓联合置管溶栓治疗急性下肢深静脉血栓疗效分析
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摘要
目的探讨球囊扩张碎栓联合置管溶栓(CDT)治疗急性下肢深静脉血栓形成(DVT)的疗效。方法回顾性分析2015年3月至2018年4月空军军医大学唐都医院普通外科收治的31例使用球囊扩张碎栓联合CDT治疗的DVT患者临床资料,计算血栓溶解率来评价即时疗效,并检测深静脉通畅率及Villalta评分测定深静脉血栓形成后综合征(PTS)发生率来评价中远期疗效。结果 31例患者即时血栓溶解率(91±27)%,成功溶解(血栓溶解率≥50%)28例(90.3%),无严重并发症发生,1、6、12、24个月深静脉再通率分别为93.5%、86.2%、71.4%和55.6%,随访2年后PTS发生率为11.1%。结论急性DVT使用球囊扩张碎栓联合CDT疗效显著,对于病程较长的患者意义更大。
Objective To explore the efficacy of catheter-directed thrombolysis(CDT) combined with balloon mashing thrombosis(BMT) for acute deep vein thrombosis(DVT) in the lower extremity. Methods The clinical data of 31 patients with acute DVT of lower extremities treated with CDT and BMT from March 2015 to April 2018 were analyzed retrospectively. Immediate efficacy assessed by thrombus score, deep vein patency and post-thrombotic syndrome(PTS) assessed by Villalta scale were evaluated. Results Of 31 patients, mean thrombus score was(91±27)%, and successful lysis(≥50%) was obtained in 28 patients(90.3)%. No major complications happened. Deep vein patency after 1, 6, 12 and 24 months were 93.5%,86.2%, 71.4% and 55.6%, respectively. The incidence of PTS was 11.1% at 2 years after surgery. Conclusion CDT combined with BMT for acute DVT is effectively, especially for patients with a longer duration.
Objective To explore the efficacy of catheter-directed thrombolysis(CDT) combined with balloon mashing thrombosis(BMT) for acute deep vein thrombosis(DVT) in the lower extremity. Methods The clinical data of 31 patients with acute DVT of lower extremities treated with CDT and BMT from March 2015 to April 2018 were analyzed retrospectively. Immediate efficacy assessed by thrombus score, deep vein patency and post-thrombotic syndrome(PTS) assessed by Villalta scale were evaluated. Results Of 31 patients, mean thrombus score was(91±27)%, and successful lysis(≥50%) was obtained in 28 patients(90.3)%. No major complications happened. Deep vein patency after 1, 6, 12 and 24 months were 93.5%,86.2%, 71.4% and 55.6%, respectively. The incidence of PTS was 11.1% at 2 years after surgery. Conclusion CDT combined with BMT for acute DVT is effectively, especially for patients with a longer duration.
引文
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[11]艾文佳,林少芒,张智辉,等.Angiojet清栓联合髂静脉腔内成形一期治疗急性下肢深静脉血栓合并髂静脉压迫综合征的疗效分析[J/CD].中国血管外科杂志(电子版),2017,9(4):258-261.
[12]芮清峰,孙振阳.导管溶栓技术在急性下肢深静脉血栓形成中的应用[J/CD].中国血管外科杂志(电子版),2017,9(2):99-101.
[13]Comerota AJ,Throm RC,Mathias SD,et al.Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life[J].J Vasc Surg,2000,32(1):130-137.
[14]郭松林,袁良喜,周建,等.急性下肢深静脉血栓置管溶栓治疗的早、中期疗效分析[J/CD].中国血管外科杂志(电子版),2013,5(2):70-73.
[15]Greenfield LJ,Proctor MC.Recurrent thromboembolism in patients with vena cava filters[J].J Vasc Surg,2001,33(3):510-514.
[16]Protack CD,Bakken AM,Patel N,et al.Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement[J].J Vasc Surg,2007,45(5):992-997.
[2]Kearon C,Akl EA,Comerota AJ,et al.Antithrombotic therapy for VTE disease:Antithrombotic Therapy and Prevention of Thrombosis,9 th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e419S-e496S.
[3]Kahn SR.The post-thrombotic syndrome[J].Hematology Am Soc Hematol Educ Program,2010,2010:216-220.
[4]Meissner MH,Gloviczki P,Comerota AJ,et al.Early thrombus removal strategies for acute deep venous thrombosis:clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum[J].J Vasc Surg,2012,55(5):1449-1462.
[5]Mewissen MW,Seabrook GR,Meissner MH,et al.Catheterdirected thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J].Radiology,1999,211(1):39-49.
[6]Kahn SR,Partsch H,Vedantham S,et al.Definition of postthrombotic syndrome of the leg for use in clinical investigations:a recommendation for standardization[J].JThromb Haemost,2009,7(5):879-883.
[7]Sillesen H,Just S,Jorgensen M,et al.Catheter directed thrombolysis for treatment of ilio-femoral deep venous thrombosis is durable,preserves venous valve function and may prevent chronic venous insufficiency[J].Eur J Vasc Endovasc Surg,2005,30(5):556-562.
[8]Leary SE,Harrod VL,de Alarcon PA,et al.Low-dose systemic thrombolytic therapy for deep vein thrombosis in pediatric patients[J].J Pediatr Hematol Oncol,2010,32(2):97-102.
[9]刘磊,冯家烜,王宏飞,等.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[J].中华血管外科杂志,2016,1(1):22-24.
[10]王磊,郭松林,阴继凯,等.AngioJet治疗急性髂股静脉血栓形成的早期疗效分析[J/CD].中国血管外科杂志(电子版),2016,8(1):25-28.
[11]艾文佳,林少芒,张智辉,等.Angiojet清栓联合髂静脉腔内成形一期治疗急性下肢深静脉血栓合并髂静脉压迫综合征的疗效分析[J/CD].中国血管外科杂志(电子版),2017,9(4):258-261.
[12]芮清峰,孙振阳.导管溶栓技术在急性下肢深静脉血栓形成中的应用[J/CD].中国血管外科杂志(电子版),2017,9(2):99-101.
[13]Comerota AJ,Throm RC,Mathias SD,et al.Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life[J].J Vasc Surg,2000,32(1):130-137.
[14]郭松林,袁良喜,周建,等.急性下肢深静脉血栓置管溶栓治疗的早、中期疗效分析[J/CD].中国血管外科杂志(电子版),2013,5(2):70-73.
[15]Greenfield LJ,Proctor MC.Recurrent thromboembolism in patients with vena cava filters[J].J Vasc Surg,2001,33(3):510-514.
[16]Protack CD,Bakken AM,Patel N,et al.Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement[J].J Vasc Surg,2007,45(5):992-997.