吸栓后导管溶栓与单纯导管溶栓对急性混合型下肢深静脉血栓的疗效比较
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摘要
目的:比较吸栓联合导管溶栓与单纯导管溶栓对急性混合型下肢深静脉血栓(LEDVT)的疗效。方法:回顾性分析2012年6月—2017年6月收治的121例急性混合型LEDVT患者资料,其中60例先吸栓再导管溶栓治疗(吸栓后溶栓组),61例直接行导管溶栓治疗(单纯溶栓组),比较两组患者的相关临床指标。结果:两组治疗前一般资料无统计学差异(均P>0.05)。与单纯溶栓组比较,吸栓后溶栓组平均住院天数明显缩短(6.2 d vs. 10.5 d,P<0.05),尿激酶平均用量明显减少(170万U vs. 290万U,P<0.05);吸栓后溶栓组与单纯溶栓组术后1周的治愈率和有效率分别为75%、45.9%与91.67%、88.52%,术后2周分别为83.33%、62.3%与96.72%,91.81%,吸栓后溶栓组治愈率明显高于单纯溶栓组(均P<0.05),有效率两组间差异无统计学意义(均P>0.05)。术后随访12个月,两组并发症发生率、膝下15 cm处健患肢周径差降低程度、静脉通畅率、静脉瓣膜功能正常率以及总有效率差异无统计学意义(均P>0.05)。结论:与单纯导管溶栓相比较,吸栓后溶栓能明显缩短急性混合型LEDVT患者住院时间,减少尿激酶用量,提高治愈率,但中长期疗效差异不大。
Objective: To compare the efficacy of thrombus aspiration combined with catheter directed thrombolysis(CDT) and CDT alone in treatment of acute mixed lower extremity deep venous thrombosis(LEDVT). Methods: The clinical data of 121 patients with acute mixed LEDVT treated during June 2012 to June 2017 were retrospectively analyzed. Of the patients, 60 cases underwent CDT after thrombus aspiration(thrombus aspiration plus CDT group) and 61 cases underwent direct CDT(CDT alone group). The main clinical variables between the two groups of patients were compared. Results: The general preoperative data showed no significant differences between the two groups(all P>0.05). In thrombus aspiration plus CDT group compared with CDT alone group, the average length of hospital stay(6.2 d vs. 10.5 d, P<0.05) and average amount of urokinase used(17×10~4 U vs. 290×10~4 U, P<0.05) were significantly reduced. In thrombus aspiration plus CDT group and CDT alone group, the cure rate and effective rate in thrombus aspiration plus CDT group on one week after treatment were 75% and 91.67% and on two weeks after treatment were 83.33% and 96.72%, and in CDT alone group on one week after treatment were 45.9% and 91.67% and on two weeks after treatment were 62.3% and 96.72%, respectively. The cure rates in thrombus aspiration plus CDT group were significantly higher than those in CDT alone group(both P<0.05), but the effective rates showed no significant differences between the two groups(both P>0.05). Follow-up was conducted at 12 months after operation, the incidence of complications, the decreasing amplitudes in differences in the circumferences at 15 cm below the knee between healthy and affected limb, the vein patency rates and normal venous valve function rates as well as the overall effective rates showed no significant differences between the two groups(all P>0.05). Conclusion: Compared with CDT alone, thrombus aspiration plus CDT can obviously decrease the length of hospitalization, decrease the dose of urokinase infusion and increase the cure rate for acute mixed LEDVT, while its mid-and long-term efficacy shows no obvious superiority.
Objective: To compare the efficacy of thrombus aspiration combined with catheter directed thrombolysis(CDT) and CDT alone in treatment of acute mixed lower extremity deep venous thrombosis(LEDVT). Methods: The clinical data of 121 patients with acute mixed LEDVT treated during June 2012 to June 2017 were retrospectively analyzed. Of the patients, 60 cases underwent CDT after thrombus aspiration(thrombus aspiration plus CDT group) and 61 cases underwent direct CDT(CDT alone group). The main clinical variables between the two groups of patients were compared. Results: The general preoperative data showed no significant differences between the two groups(all P>0.05). In thrombus aspiration plus CDT group compared with CDT alone group, the average length of hospital stay(6.2 d vs. 10.5 d, P<0.05) and average amount of urokinase used(17×10~4 U vs. 290×10~4 U, P<0.05) were significantly reduced. In thrombus aspiration plus CDT group and CDT alone group, the cure rate and effective rate in thrombus aspiration plus CDT group on one week after treatment were 75% and 91.67% and on two weeks after treatment were 83.33% and 96.72%, and in CDT alone group on one week after treatment were 45.9% and 91.67% and on two weeks after treatment were 62.3% and 96.72%, respectively. The cure rates in thrombus aspiration plus CDT group were significantly higher than those in CDT alone group(both P<0.05), but the effective rates showed no significant differences between the two groups(both P>0.05). Follow-up was conducted at 12 months after operation, the incidence of complications, the decreasing amplitudes in differences in the circumferences at 15 cm below the knee between healthy and affected limb, the vein patency rates and normal venous valve function rates as well as the overall effective rates showed no significant differences between the two groups(all P>0.05). Conclusion: Compared with CDT alone, thrombus aspiration plus CDT can obviously decrease the length of hospitalization, decrease the dose of urokinase infusion and increase the cure rate for acute mixed LEDVT, while its mid-and long-term efficacy shows no obvious superiority.
引文
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[9]罗定远,黎洪浩,龙淼云,等.手术取栓与药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效比较[J].中华普通外科杂志,2010,25(11):876-879.doi:10.3760/cma.j.issn.1007-631X.2010.11.006.Luo DY,Li HH,Long MY,et al.Thrombectomy and pharmacological thrombolysis for acute iliofemoral lower extremity deep venous thrombosis[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2010,25(11):876-879.doi:10.3760/cma.j.issn.1007-631X.2010.11.006.
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[12]Vedantham S,Vesely TM,Parti N,et al.Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy[J].J Vasc Interv Radiol,2002,13(10):1001-1008.
[13]Frisoli JK,Sze D.Mechanical thrombectomy for the treatment of lower extremity deep vein thrombosis[J].Tech Vasc Interv Radiol,2003,6(1):49-52.doi:10.1053/tvir.2003.36439.
[14]张希全,王义平,朱伟,等.微创治疗髂静脉闭塞合并下肢深静脉血栓形成[J].中国介入影像与治疗学,2012,9(12):843-846.Zhang XQ,Wang YP,Zhu W,et al.Minimally invasive treatment of common iliac vein occlusion combined with lower extremity deep venous thrombosis[J].Chinese Journal of Interventional Imaging and Therapy,2012,9(12):843-846.
[15]O?uzkurt L,Ozkan U,Gülcan O,et a1.Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis by using manual aspiration thrombectomy:long-term results of 139 patients in a single center[J]Diagn Interv Radiol,2012,18(4):410-416.doi:10.4261/1305-3825.DIR.5175-11.1.
[16]Kwak HS,Han YM,Lee YS,et al.Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis:early and late results[J].J Vasc Interv Radiol,2005,16(6):815-822.doi:10.1097/01.RVI.0000157690.91690.38.
[17]Park SI,Lee M,Lee MS,et al.Single-session aspiration thrombectomy of lower extremity deep vein thrombosis using largesize catheter without pharmacologic thrombolysis[J].Cardiovasc Intervent Radiol,2014,37(2):412-419.doi:10.1007/s00270-013-0676-1.
[18]谷涌泉,张建,齐立行,等.急性重症下肢深静脉血栓形成的外科治疗[J].中华医学杂志,2009,89(45):3186-3188.doi:10.3760/cma.j.issn.0376-2491.2009.45.006.Gu YQ,Zhang J,Qi LX,et al.Treatment of severe acute deep venous thrombosis in lower extremity[J].National Medical Journal of China,2009,89(45):3186-3188.doi:10.3760/cma.j.issn.0376-2491.2009.45.006.
[19]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(第二版)[J].中华普通外科杂志,2012,27(7):605-607.doi:10.3760/cma.j.issn.1007-631X.2012.07.033.Vascular Surgery Group of Surgery Society of Chinese medical Association.Guidelines for diagnosis and treatment of deep venous thrombosis(the Second Edition)[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2012,27(7):605-607.doi:10.3760/cma.j.issn.1007-631X.2012.07.033.
[20]Vedantham S,Thorpe PE,Cardella JF,et al.Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J].J Vasc Interv Radiol,2009,20(7 Suppl):S227-239.doi:10.1016/j.jvir.2009.04.016.
[2]Baglin T.What happens after venous thromboembolism?[J].JThromb Haemost,2009,7(Suppl 1):287-290.doi:10.1111/j.1538-7836.2009.03409.x.
[3]孙毅,孙国华,王胜甲,等.下肢深静脉血栓形成后遗症的外科手术治疗[J].中国普通外科杂志,2002,11(7):402-404.Sun Y,Sun GH,Wang SJ,et al.Surgical treatment of the sequel of deep vein thrombosis of lower extremi[J].Chinese Journal of General Surgery,2002,11(7):402-404.
[4]蔡林刚,任为.下肢深静脉血栓形成后综合征治疗的进展[J].中国普通外科杂志,2008,17(6):599-601.doi:10.3969/j.issn.1005-6947.2008.06.019.Cai LG,Ren W.Advances in the treatment of post-thromboemblic syndrome of deep venous of lower extremities[J].Chinese Journal of General Surgery,2008,17(6):599-601.doi:10.3969/j.issn.1005-6947.2008.06.019.
[5]张青云,高建国,陈泳,等.综合介入治疗在38例下肢深静脉血栓形成中的临床分析[J].重庆医学,2011,40(8):816-818.doi:10.3969/j.issn.1671-8348.2011.08.036.Zhang QY,Gao JG,Chen Y,et al.Clinical analysis of integrated intentional therapy for 38 cases with deep venous thrombosis of the lower limbs[J].Chongqing Medicine,2011,40(8):816-818.doi:10.3969/j.issn.1671-8348.2011.08.036.
[6]万圣云,徐周纬,丁洋,等.下肢深静脉血栓形成的综合治疗[J].中国普通外科杂志,2009,18(12):1255-1258.Wan SY,Xu ZW,Ding Y,et al.The combined therapy of lower extremity deep vein thrombosis[J].Chinese Journal of General Surgery,2009,18(12):1255-1258.
[7]庄金满,赵军.下肢深静脉血栓手术取栓与介入取栓疗效的比较研究[J].中国微创外科杂志,2010,10(12):1075-1078.doi:10.3969/j.issn.1009-6604.2010.12.008.Zhuang JM,Zhao J.Comparison of Surgical Thrombectomy with Interventional Thrombectomy for Deep Vein Thrombosis of the Lower Extremity[J].Chinese Journal of Minimally Invasive Surgery,2010,10(12):1075-1078.doi:10.3969/j.issn.1009-6604.2010.12.008.
[8]崔明哲.两种不同途径溶栓治疗下肢深静脉血栓的疗效比较[J].中国普通外科杂志,2010,19(6):659-661.Cui MZ.Comparison of with two different routes of thrombolytic therapy for deep venous thrombosis[J].Chinese Journal of General Surgery,2010,19(6):659-661.
[9]罗定远,黎洪浩,龙淼云,等.手术取栓与药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效比较[J].中华普通外科杂志,2010,25(11):876-879.doi:10.3760/cma.j.issn.1007-631X.2010.11.006.Luo DY,Li HH,Long MY,et al.Thrombectomy and pharmacological thrombolysis for acute iliofemoral lower extremity deep venous thrombosis[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2010,25(11):876-879.doi:10.3760/cma.j.issn.1007-631X.2010.11.006.
[10]Delis KT,Bountouroglou D,Mansfield AO.Venous claudication in iliofemoral thrombosis:long-term effects on venous hemodynamics,clinical status,and quality of life[J].Ann Surg,2004,239(1):118-126.doi:10.1097/01.sla.0000103067.10695.74.
[11]李晓强,段鹏飞,钱爱民,等.介入联合手术治疗急性下肢深静脉血栓形成[J].中华普通外科杂志,2006,21(9):660-661.doi:10.3760/j.issn:1007-631X.2006.09.015.Li XQ,Duan PF,Qian AM,et al.Interventional and surgical therapy for acute deep vein thrombosis of the lower extremity[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2006,21(9):660-661.doi:10.3760/j.issn:1007-631X.2006.09.015.
[12]Vedantham S,Vesely TM,Parti N,et al.Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy[J].J Vasc Interv Radiol,2002,13(10):1001-1008.
[13]Frisoli JK,Sze D.Mechanical thrombectomy for the treatment of lower extremity deep vein thrombosis[J].Tech Vasc Interv Radiol,2003,6(1):49-52.doi:10.1053/tvir.2003.36439.
[14]张希全,王义平,朱伟,等.微创治疗髂静脉闭塞合并下肢深静脉血栓形成[J].中国介入影像与治疗学,2012,9(12):843-846.Zhang XQ,Wang YP,Zhu W,et al.Minimally invasive treatment of common iliac vein occlusion combined with lower extremity deep venous thrombosis[J].Chinese Journal of Interventional Imaging and Therapy,2012,9(12):843-846.
[15]O?uzkurt L,Ozkan U,Gülcan O,et a1.Endovascular treatment of acute and subacute iliofemoral deep venous thrombosis by using manual aspiration thrombectomy:long-term results of 139 patients in a single center[J]Diagn Interv Radiol,2012,18(4):410-416.doi:10.4261/1305-3825.DIR.5175-11.1.
[16]Kwak HS,Han YM,Lee YS,et al.Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis:early and late results[J].J Vasc Interv Radiol,2005,16(6):815-822.doi:10.1097/01.RVI.0000157690.91690.38.
[17]Park SI,Lee M,Lee MS,et al.Single-session aspiration thrombectomy of lower extremity deep vein thrombosis using largesize catheter without pharmacologic thrombolysis[J].Cardiovasc Intervent Radiol,2014,37(2):412-419.doi:10.1007/s00270-013-0676-1.
[18]谷涌泉,张建,齐立行,等.急性重症下肢深静脉血栓形成的外科治疗[J].中华医学杂志,2009,89(45):3186-3188.doi:10.3760/cma.j.issn.0376-2491.2009.45.006.Gu YQ,Zhang J,Qi LX,et al.Treatment of severe acute deep venous thrombosis in lower extremity[J].National Medical Journal of China,2009,89(45):3186-3188.doi:10.3760/cma.j.issn.0376-2491.2009.45.006.
[19]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(第二版)[J].中华普通外科杂志,2012,27(7):605-607.doi:10.3760/cma.j.issn.1007-631X.2012.07.033.Vascular Surgery Group of Surgery Society of Chinese medical Association.Guidelines for diagnosis and treatment of deep venous thrombosis(the Second Edition)[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2012,27(7):605-607.doi:10.3760/cma.j.issn.1007-631X.2012.07.033.
[20]Vedantham S,Thorpe PE,Cardella JF,et al.Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal[J].J Vasc Interv Radiol,2009,20(7 Suppl):S227-239.doi:10.1016/j.jvir.2009.04.016.