摘要
目的评价手动机械性血栓碎吸治疗不同类型急性下肢深静脉血栓形成的中、长期疗效。资料与方法 745例急性、亚急性下肢深静脉血栓形成患者,其中中央型258例(A组),混合型487例(B组),均经健侧股静脉安置下腔静脉滤器,患侧股静脉插入12～14F鞘管手动机械性碎吸血栓。287例合并髂总静脉狭窄或闭塞,采取经皮腔内血管成形术和支架植入处理。评价两组患者的近期疗效及中、长期疗效。结果 A组治疗过程中无严重并发症发生,B组溶栓过程中2例因严重出血危及生命。出院时所有患者健患肢膝上、下15cm处周径差均较术前明显减小(t=19.37、23.99、21.98、24.06,P<0.01)。末次随访发现,A组水肿、色素沉着、溃疡的发生率分别为27.91%、13.18%、0,明显低于B组的35.11%、22.59%、2.46%(χ2=3.98、9.58、5.00,P<0.05);A组静脉通畅率及瓣膜功能正常率分别为96.51%、78.68%,明显高于B组的75.36%、55.03%(χ2=52.71、40.57,P<0.01);A组疗效优良率为99.22%,高于B组的82.75%(χ2=96.10,P<0.01)。结论机械性血栓碎吸治疗急性中央型下肢深静脉血栓形成的中、长期疗效好,对于混合型下肢深静脉血栓应采用血栓碎吸配合系统溶栓以提高疗效,根据血栓解剖分布类型指导治疗方案的选择。
Purpose To evaluate the intermediate and long-term efficacy of mechanical aspiration thrombectomy for different anatomical distributions of lower extremity deep venous thrombosis （LEDVT）. Materials and Methods 745 patients with acute and subacute LEDVT including 258 cases of central type （group A） and 487 cases of mixed type （group B） were implanted inferior vena cava filter via femoral vein, then an 12-14F catheter was inserted to the femoral vein of affected limbs to aspirate thrombus mechanically. 287 cases with stenosis or occlusion of common lilac vein underwent PTA and stenting. The short-term, intermediate and long-term efficacy of all patients were evaluated. Results No one patient in group A occurred severe complication during interventional therapy, and two patients in group B occurred life-threatening severe bleeding. The circumference difference between healthy and affected limbs 15 cm above and below knee were statistically decreased than that before therapy （t = 19.37, 23.99, 21.98, 24.06, P〈0.01 ）. The incidences of edema, pigmentation and ulceration at last follow-up of group A were 27.91%, 13.18%, 0, respectively, which were significantly lower than group B of35.11%, 22.59%, 2.46% （χ2=3.98, 9.58, 5.00, P〈0.05）. The venous patency rate and normal valve function rate of group A were 96.51% and 78.68%, which were statistically higher than group B of 75.36% and 55.03% （χ2=52.71,40.57, P〈0.01）. The good clinical efficacy rate of group A was 99.22%, which was obviously higher than group B of 82.75% （χ2=96.10, P〈0.01）. Conclusion Mechanical aspiration thrombectomy has a good intermediate and long-term efficacy for central type lower extremity acute deep venous thrombosis, and mechanical aspiration thrombectomy combined with systemic thrombolysis is suitable for mixed type lower extremity acute deep venous thrombosis, interventional therapy regimen can be selected according to the type of anatomical distribution for thrombosis in clinic.
出处
《中国医学影像学杂志》
CSCD
北大核心
2013年第2期95-100,104,共7页
Chinese Journal of Medical Imaging
关键词
静脉血栓形成
下肢
机械性血栓碎吸
Venous thrombosis
Lower extremity
Mechanical aspiration thrombectomy
