临床外科杂志 ›› 2020, Vol. 28 ›› Issue (6): 511-514.doi: 10.3969/j.issn.1005-6483.2020.06.004

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经对侧股静脉入路机械吸栓结合导管溶栓治疗急性全肢型下肢深静脉血栓形成的中期效果分析

  

  1. 上海交通大学医学院附属第九人民医院血管外科
  • 出版日期:2020-06-20 发布日期:2020-06-20

The mid term effect of mechanical thrombectomy combined with catheter directed thrombolysis via contralateral femoral vein approach in the treatment of acute lower extremity deep vein thrombosis

  • Online:2020-06-20 Published:2020-06-20

摘要: 目的:分析经对侧股静脉入路行经皮机械吸栓(percutaneous mechanical thrombectomy,PMT)结合导管溶栓(catheterdirected thrombolysis,CDT)治疗全肢型急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的治疗效果。方法:从2016年9月至2017年8月,45例病人接受了经对侧入路的PMT+CDT治疗,其中早期血栓组(0~7天)23例,晚期(8~14天)血栓组22例,分析比较两组病人股静脉瓣膜反流、血管再通情况以及下肢深静脉血栓形成后综合征(postthrombotic syndrome,PTS)发生率。结果:在20个月随访期间,观察到37例病人保存完好的股静脉瓣膜功能,两组间无统计学差异;所有髂静脉再通;早期血栓组股腘(23比17)及小腿静脉(22比17)再通例数高于晚期血栓组。PTS发生率为22%,早期血栓组优于晚期血栓组,无PTS发生。结论:中期随访结果证实对急性全肢型下肢DVT采用对侧入路进行PMT+CDT是一种可行的方法,早期血栓组中PTS发生率较晚期血栓组低。

关键词: 对侧股静脉入路, 经皮机械吸栓, 导管接触溶栓, 下肢深静脉血栓形成后综合征

Abstract: Objective:To analyze the follow up effect of acute deep venous thrombosis(DVT)of the lower extremities through a contralateral femoral vein approach by percutaneous mechanical thrombolysis(PMT)combined with catheterdirected thrombolytic(CDT)therapy.Methods:From September 2016 to August 2017,45 patients were treated with PMT + CDT via contralateral approach,including 23 patients in the early thrombus group(0~7 days)and 22 patients in the late thrombus group(8~14 days).The competent femoral valves,venous recanalization and the postthrombotic syndrome(PTS)rate in the two groups were analyzed and compared.Results:During the followup period of 20 months,37 patients with intact femoral vein valve function were observed,there was no statistical difference between the two groups;all iliac vein recanalization;the number of femoral popliteal recanalization(23 vs 17)and calf vein recanalization(22 vs 17)in the early thrombus group was higher than that in the late thrombus group.The incidence of post thrombosis syndrome(PTS)was 22%.and the early thrombus group was superior to the late thrombus group(10 vs.0).Conclusion:The results of midterm followup confirmed that it is a feasible method to use contralateral approach to PMT + CDT for extensive acute DVT The incidence of PTS in early thrombus group was lower than that in late thrombus group.

Key words: contralateral femoral vein approach, percutaneous mechanical thrombectomy, catheterdirected thrombolysis, postthrombotic syndrome

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