摘要
目的 分析比较机械性抽吸与溶栓抗凝治疗急性混合型下肢深静脉血栓形成的疗效.方法 回顾性分析380例急性混合型下肢深静脉血栓患者的临床资料,根据治疗方法分为两组.A组（229例）：采用局麻下经皮穿刺患侧股静脉,导丝引导下插入12～ 14 F鞘管直接抽吸髋上髂、股静脉内血栓,髋下股、腘静脉血栓,利用Fogarty取栓球囊导管将血栓拖拉至髂、股内,再经患侧股静脉机械性抽吸血栓；髂、股、腘静脉血栓清除后,113例造影显示髂静脉存在狭窄或闭塞,行经皮血管腔内成行术或支架置入辅助处理；腘静脉以下残存血栓,术后辅以小剂量尿激酶溶栓和肝素抗凝.B组（151例）：采用单纯尿激酶溶栓、肝素抗凝.结果 患肢肿胀、疼痛开始消退或减轻；A组术后当日,而B组则于术后3-7d.血栓完全清除（Ⅰ级）：A组（63.32％）明显高于B组（37.09％）（x2=20.53,P=0.002）.结论 急性混合型下肢深静脉血栓机械性血栓抽吸优于单纯抗凝溶栓治疗,尤其在保护静脉瓣膜功能方面更具优势；血栓抽吸配合髂静脉成形是治疗髂静脉受压综合征合并急性深静脉血栓形成更为有效的治疗方法.
Objective To compare the clinical effect of manual aspiration thrombectomy versus systemic thrombolysis for acute lower extremity deep venous thrombosis of mixed type.Methods The clinical data of 380 patients with acute lower extremity deep venous thrombosis of nixed type was analyzed retrospectively,who were classified into two groups according to treatment methods.Group A （229 cases）：the ipsilateral femoral vein was accessed under local anesthesia,a 12-14 F sheath was introduced via a guide wire to aspirate iliofenoral thrombus.As for the femoropopliteal thrombus,a Fogarty balloon catheter was introduced to pull thrombus to iliac vein,then mechanical aspiration thrombectomy was performed.One hundred and thirteen patients with stenosis or occlusion of comnon iliac vein were treated with adjunctive PTA and stenting.As for the residual thrombus bclow popliteal vein,a small dose urokinase vas given to thrombolysis and heparin anticoagulation after procedure.Group B（151 cases） were treated by systemic thrombolysis and anticoagulation with heparin.Results The swelling and pain of affected limbs of group A began to relief after operation immediately,but these times of group B was 3-7 days after operation.The thrombus was eliminated completely（Grade Ⅰ）：goup A was better than group B （63.32％ vs 37.09％） （x2 =20.53,P =0.002）.Conclusions The manual aspiration thrombectomy was superior to simple systemic thrombolysis in treating acute lower extremity deep venous thrombosis of mixed type,especially in protecting the normal valve function that was better than thrombolysis,aspiration thrombectomy with adjunctive iliac vein angioplasty was a more reasonable method to treat acute LEDVT.
出处
《国际外科学杂志》
2013年第9期607-610,共4页
International Journal of Surgery
关键词
下肢深静脉血栓形成
抽吸
抗凝药
溶栓
Lower extremity deep venous thrombosis
Suction
Anticoagulats
Systemic thrombolysis
