髂静脉重度狭窄继发急性左下肢深静脉血栓形成——支架植入时机研究
|
摘要
目的探讨支架植入时机对髂静脉重度狭窄继发急性左下肢深静脉血栓形成(DVT)患者溶栓治疗的影响。方法回顾性分析2014年1月至2017年5月收治的44例髂静脉重度狭窄继发急性左下肢DVT患者临床资料。A组(18例)导管接触溶栓(CDT)前植入髂静脉支架,B组(26例)CDT后植入髂静脉支架。比较两组患者患肢消肿率、血栓清除率、尿激酶用量、溶栓导管留置时间、住院治疗费用及并发症发生率。结果 A组植入支架18枚,B组植入26枚,随访期间支架均通畅,无移位、断裂等并发症。A组发生出血并发症2例,B组3例,均未出现症状性肺栓塞。A、B组患肢大腿消肿率分别为(70.63±20.02)%、(68.87±32.35)%,小腿消肿率分别为(63.28±20.34)%、(69.53±22.50)%,血栓清除率分别为(91.32±15.09)%、(96.00±4.67)%,组间差异均无统计学意义(P>0.05)。A、B组尿激酶用量分别为(170.00±73.32)×10~4U、(240.00±114.82)×104U,导管留置时间分别为(2.97±1.50) d、(4.77±3.09) d,住院治疗费用分别为(47 423.40±12 952.78)元、(55 998.44±7 094.25)元,组间差异均有统计学意义(P=0.018、P=0.014、P=0.017)。结论髂静脉重度狭窄继发急性左下肢DVT患者接受CDT前植入髂静脉支架新模式治疗,可减少尿激酶用量,缩短导管留置时间,降低治疗费用。
Objective To investigate the effect of the timing of stent implantation on the curative effect of thrombolytic therapy for acute deep venous thrombosis(DVT) of left lower extremity secondary to severe iliac vein stenosis. Methods The clinical data of 44 patients with acute DVT of left lower extremity secondary to severe iliac vein stenosis, who were admitted to authors' hospital during the period from January 2014 to May 2017 to receive treatment, were retrospectively analyzed. The patients were divided into group A(n =18) and group B(n =26). For the patients of group A, stent implantation of iliac vein was performed before catheter-directed thrombolysis(CDT) therapy. For the patients of group B, stent implantation of iliac vein was performed after CDT therapy. The swelling regression rate of the affected extremity, the thrombus removal rate, the used dose of urokinase, the thrombolytic catheter retention time, the hospitalization expenses, and the occurrence of complications were calculated, and the result was compared between the two groups. Results A total of 18 stents were implanted in group A, and a total of 26 stents were implanted in group B. During the follow-up period, all the stents were unobstructed and no displacement or fracture of the stent occurred. Hemorrhage occurred in two patients of group A and in three patients of group B. No symptomatic pulmonary em bolism occurred. In group A and group B, the swelling regression rates of the affected thighs were(70.63±20.02)% and(68.87±32.35)% respectively, the swelling regression rates of the affected legs were(63.28±20.34)% and(69.53±22.50)% respectively, the thrombus removal rates were(91.32±15.09)% and(96.00 ±4.67)% respectively; the differences between the two groups were not statistically significant(P>0.05). In group A and in group B, the used doses of urokinase were(170.00±73.32)×10~4U and(240.00±114.82)×10~4U respectively, the thrombolytic catheter retention days were(2.97±1.50) days and(4.77±3.09) days respectively, the hospitalization expenses were(47 423.40±12 952.78) RMB and(55 998.44±7 094.25) RMB respectively. The differences in all the above three indexes between the two groups were statistically significant(P =0.018,P =0.014 and P =0.017, respectively). Conclusion For the treatment of patients with acute DVT of left lower extremity secondary to severe iliac vein stenosis, the new therapeutic mode, i.e. stent implantation of iliac vein followed by CDT, can decrease the dosage of urokinase, shorten the thrombolytic catheter retention time, and reduce the cost of treatment.
Objective To investigate the effect of the timing of stent implantation on the curative effect of thrombolytic therapy for acute deep venous thrombosis(DVT) of left lower extremity secondary to severe iliac vein stenosis. Methods The clinical data of 44 patients with acute DVT of left lower extremity secondary to severe iliac vein stenosis, who were admitted to authors' hospital during the period from January 2014 to May 2017 to receive treatment, were retrospectively analyzed. The patients were divided into group A(n =18) and group B(n =26). For the patients of group A, stent implantation of iliac vein was performed before catheter-directed thrombolysis(CDT) therapy. For the patients of group B, stent implantation of iliac vein was performed after CDT therapy. The swelling regression rate of the affected extremity, the thrombus removal rate, the used dose of urokinase, the thrombolytic catheter retention time, the hospitalization expenses, and the occurrence of complications were calculated, and the result was compared between the two groups. Results A total of 18 stents were implanted in group A, and a total of 26 stents were implanted in group B. During the follow-up period, all the stents were unobstructed and no displacement or fracture of the stent occurred. Hemorrhage occurred in two patients of group A and in three patients of group B. No symptomatic pulmonary em bolism occurred. In group A and group B, the swelling regression rates of the affected thighs were(70.63±20.02)% and(68.87±32.35)% respectively, the swelling regression rates of the affected legs were(63.28±20.34)% and(69.53±22.50)% respectively, the thrombus removal rates were(91.32±15.09)% and(96.00 ±4.67)% respectively; the differences between the two groups were not statistically significant(P>0.05). In group A and in group B, the used doses of urokinase were(170.00±73.32)×10~4U and(240.00±114.82)×10~4U respectively, the thrombolytic catheter retention days were(2.97±1.50) days and(4.77±3.09) days respectively, the hospitalization expenses were(47 423.40±12 952.78) RMB and(55 998.44±7 094.25) RMB respectively. The differences in all the above three indexes between the two groups were statistically significant(P =0.018,P =0.014 and P =0.017, respectively). Conclusion For the treatment of patients with acute DVT of left lower extremity secondary to severe iliac vein stenosis, the new therapeutic mode, i.e. stent implantation of iliac vein followed by CDT, can decrease the dosage of urokinase, shorten the thrombolytic catheter retention time, and reduce the cost of treatment.
引文
[1] Betensky M, Bittles MA, Colombani P, et al. How we manage pediatric deep venous thrombosis[J]. Semin Intervent Radiol,2017, 34:35-49.
[2]吴霜,顾建平,楼文胜.髂静脉受压综合征病因及诊疗研究进展[J].介入放射学杂志, 2015, 24:733-737.
[3]丁锦辉,丁贺义,蒋米尔.下肢深静脉血栓腔内治疗进展[J].临床外科杂志, 2016, 24:638-640.
[4] Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J]. Chest,2016, 149:315-352.
[5] Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy:final report of the prospective multicenter PEARL(peripheral use of AngioJet rheolytic thrombectomy with a variety of catheter lengths)registry[J]. J Vasc Interv Radiol, 2015, 26:777-785.
[6] Sista AK, Vedantham S, Kaufman JA, et al. Endovascular interventions for acute and chronic lower extremity deep venous disease:state of the art[J]. Radiology, 2015, 276:31-53.
[7]李智,倪才方,金泳海,等.球囊扩张辅助经导管直接溶栓治疗急性下肢深静脉血栓[J].中华放射学杂志, 2012, 46:561-566.
[8] Carr S, Chan K, Rosenberg J, et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis[J]. J Vasc Interv Radiol, 2012, 23:1467-1472.
[9] Ming ZB, Li WD, Yuan RF, et al. Effectiveness of catheter directed thrombolysis and stent implantation on iliofemoral vein thrombosis caused by iliac vein compression[J]. J Thromb Thrombolysis, 2017, 44:254-260.
[10]黄献琛,陈万海,李春荣,等.介入治疗急性左髂股静脉血栓——先溶栓或先扩张[J].介入放射学杂志, 2011, 20:688-691.
[11] Matsuda A, Yamada N, Ogihara Y, et al. Early and long-term outcomes of venous stent implantation for iliac venous stenosis after catheter-directed thrombolysis for acute deep vein thrombosis[J]. Circ J, 2014, 78:1234-1239.
[12]赵国瑞,任建庄,段旭华,等.腔内介入治疗Cockett综合征伴左下肢深静脉血栓形成[J].介入放射学杂志, 2017, 26:522-526.
[13]虞丰,李晓强.髂静脉受压综合征腔内治疗继发支架内和对侧血栓形成[J].中华普通外科杂志, 2016, 31:967-968.
[14]中华医学会放射学分会介入学组.下肢深静脉血栓形成介入治疗规范的专家共识[J].介入放射学杂志, 2011, 45:293-296.
[15] Chan KT, Popat RA, Sze DY, et al. Common iliac vein stenosis and risk of symptomatic pulmonary embolism:an inverse correlation[J]. J Vasc Interv Radiol, 2011, 22:133-141.
[16]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[J].中华放射学杂志, 2011, 45:297-300.
[2]吴霜,顾建平,楼文胜.髂静脉受压综合征病因及诊疗研究进展[J].介入放射学杂志, 2015, 24:733-737.
[3]丁锦辉,丁贺义,蒋米尔.下肢深静脉血栓腔内治疗进展[J].临床外科杂志, 2016, 24:638-640.
[4] Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J]. Chest,2016, 149:315-352.
[5] Garcia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy:final report of the prospective multicenter PEARL(peripheral use of AngioJet rheolytic thrombectomy with a variety of catheter lengths)registry[J]. J Vasc Interv Radiol, 2015, 26:777-785.
[6] Sista AK, Vedantham S, Kaufman JA, et al. Endovascular interventions for acute and chronic lower extremity deep venous disease:state of the art[J]. Radiology, 2015, 276:31-53.
[7]李智,倪才方,金泳海,等.球囊扩张辅助经导管直接溶栓治疗急性下肢深静脉血栓[J].中华放射学杂志, 2012, 46:561-566.
[8] Carr S, Chan K, Rosenberg J, et al. Correlation of the diameter of the left common iliac vein with the risk of lower-extremity deep venous thrombosis[J]. J Vasc Interv Radiol, 2012, 23:1467-1472.
[9] Ming ZB, Li WD, Yuan RF, et al. Effectiveness of catheter directed thrombolysis and stent implantation on iliofemoral vein thrombosis caused by iliac vein compression[J]. J Thromb Thrombolysis, 2017, 44:254-260.
[10]黄献琛,陈万海,李春荣,等.介入治疗急性左髂股静脉血栓——先溶栓或先扩张[J].介入放射学杂志, 2011, 20:688-691.
[11] Matsuda A, Yamada N, Ogihara Y, et al. Early and long-term outcomes of venous stent implantation for iliac venous stenosis after catheter-directed thrombolysis for acute deep vein thrombosis[J]. Circ J, 2014, 78:1234-1239.
[12]赵国瑞,任建庄,段旭华,等.腔内介入治疗Cockett综合征伴左下肢深静脉血栓形成[J].介入放射学杂志, 2017, 26:522-526.
[13]虞丰,李晓强.髂静脉受压综合征腔内治疗继发支架内和对侧血栓形成[J].中华普通外科杂志, 2016, 31:967-968.
[14]中华医学会放射学分会介入学组.下肢深静脉血栓形成介入治疗规范的专家共识[J].介入放射学杂志, 2011, 45:293-296.
[15] Chan KT, Popat RA, Sze DY, et al. Common iliac vein stenosis and risk of symptomatic pulmonary embolism:an inverse correlation[J]. J Vasc Interv Radiol, 2011, 22:133-141.
[16]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[J].中华放射学杂志, 2011, 45:297-300.