临床外科杂志 ›› 2018, Vol. 26 ›› Issue (11): 810-813.doi: 10.3969/j.issn.10056483.2018.11.004

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经皮机械性血栓清除术治疗创伤病人下肢深静脉血栓形成的安全性和早期疗效分析

  

  1. 316100  浙江省舟山市普陀医院血管外科(林佩达、王福音、何冰冰);上海交通大学医学院附属第九人民医院血管外科/上海交通大学血管病诊治中心(黄家麒、卢化祥、黄晟、刘光、杨广林、刘晓兵)
  • 收稿日期:2018-08-17 出版日期:2018-11-20 发布日期:2018-12-03
  • 通讯作者: 刘晓兵,Email:benny_liuxb@163.com

Safety and early efficacy analysis of pharmacomechanical thrombectomy for the treatment of trauma patients with lower extremity deep venous thrombosis

  1. Department of Vascular Surgery,Puotuo Hospital of Zhoushan City,Zhejiang Province,Zhoushan 316100,China
  • Received:2018-08-17 Online:2018-11-20 Published:2018-12-03

摘要: 目的   评价经皮机械性血栓清除术(PMT)治疗创伤病人下肢深静脉血栓形成(DVT)的安全性和早期疗效。方法 急性下肢深静脉血栓形成(髂股静脉)病人45例,其中非创伤性DVT(对照组)24例,创伤性DVT(创伤组)21例,两组病人均首选PMT治疗,后续辅以导管接触性溶栓(CDT)或支架植入,比较两组病人手术参数,术后并发症发生率、术前术后VRI评分、Villalta评分及1年通畅率。结果  对照组溶栓时间为(2.23±0.60)天,创伤组为(1.60±0.52)天,两组比较差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05),其中对照组术后新发2例症状性肺动脉栓塞(PE)。对照组与创伤组病人症状改善(70.83% 比 76.19%),两组术前VRI评分分别为(12.71±1.73)分和(12.52±1.33)分,术后VRI评分分别为(2.71±2.29)分和(3.14±1.56)分,Villalta评分分别为(2.39±1.31)分和(2.90±1.55),1年通畅率分别为83.33% 和 95.24%,两组比较差异无统计学意义(P>0.05)。结论  PMT治疗创伤性DVT病人有效且较为安全,早期疗效较好。

关键词: 经皮机械性血栓清除术, 下肢深静脉血栓形成, 创伤, 导管接触性溶栓

Abstract: Objective   To compare the treatment outcome in patients with acute proximal deep vein thrombosis(DVT)between the two groups,whether pharmacomechanical thrombectomy(PMT)is suitable for patients with trauma for its’ safety and efficacy.Method  45 patients underwent AngioJet rheolytic thrombectomy with/without conjunctive stent implantation or catheterdirected thrombolysis(CDT)and staged stenting were divided into the control group and trauma group.Comparing the complications between two groups,and the risk of postthrombotic syndrome(PTS)was evaluated according to the Villalta scale.A venogram was performed to assess patency follow to 1 year.Results  The CDT time of the control group[(2.23±0.60)d] was noted longer compared with that [(1.60±0.52)d] in the trauma group(P<0.05).There was no difference of postoperative complication between the two groups(P>0.05),but 2 patients had new PE in the control group after procedure.Comparing the both group with immediate(24 hour)clinical improvement(70.83% vs 76.19%),preoperative VRI scores [(12.71±1.73)vs(12.52±1.33)],postoperative VRI scores[(2.71±2.29)vs(3.14±1.56)],Villalta score at one year[(2.39±1.31)vs(2.90±1.55)],and the primary patency rate at 1 year (83.33% vs 95.24%) reveal no statistical differences(P>0.05).Conclusion  PMT maybe a safe and efficient treatment for the DVT patients with trauma as contraindication of CDT.

Key words: pharmacomechanical thrombectomy, deep vein thrombosis, trauma, catheterdirected thrombolysis

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