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中华普通外科学文献(电子版) ›› 2013, Vol. 07 ›› Issue (05) : 378 -382. doi: 10.3877/cma.j.issn.1674-0793.2013.05.012

所属专题: 文献

论著

下肢深静脉血栓形成的血管腔内治疗
于伟娜1, 张希全1,(), 王义平2, 潘晓琳1, 朱亮2, 郝斌1   
  1. 1. 255300 淄博,解放军第148医院介入血管科
    2. 潍坊医学院医学影像系
  • 收稿日期:2013-03-15 出版日期:2013-10-01
  • 通信作者: 张希全
  • 基金资助:
    济南军区计划资助项目(JII5Z016)

Endovascular therapy for lower extremity deep venous thrombosis

Wei-na YU1, Xi-quan ZHANG1,(), Yi-ping WANG2, Xiao-lin PAN1, Liang ZHU2, Bin HAO1   

  1. 1. Department of Interventional Vascular, the 148th Hospital of Chinese People's Liberation Army, Zibo 255300, China
  • Received:2013-03-15 Published:2013-10-01
  • Corresponding author: Xi-quan ZHANG
  • About author:
    Corresponding author: ZHANG Xi-quan, Email:
引用本文:

于伟娜, 张希全, 王义平, 潘晓琳, 朱亮, 郝斌. 下肢深静脉血栓形成的血管腔内治疗[J/OL]. 中华普通外科学文献(电子版), 2013, 07(05): 378-382.

Wei-na YU, Xi-quan ZHANG, Yi-ping WANG, Xiao-lin PAN, Liang ZHU, Bin HAO. Endovascular therapy for lower extremity deep venous thrombosis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2013, 07(05): 378-382.

目的

探讨腔内治疗下肢深静脉血栓形成(LEDVT)的临床效果。

方法

回顾性分析2000年1月至2010年12月收治的1068例LEDVT患者临床资料,其中中央型311例,混合型549例,周围型208例。足背静脉、股静脉穿刺造影,下腔静脉滤器植入,进行机械性血栓抽吸,取栓后造影髂静脉存在严重狭窄(>50%)或闭塞时则球囊扩张和支架植入,残留血栓术后辅助溶栓治疗。随访评估患者腔内治疗的近期、中期疗效。

结果

近期疗效Ⅰ级65.45%,Ⅱ级25.75%,Ⅲ级8.05%,Ⅳ级0.75%;总有效率99.25%,不同分型的疗效差异均有统计学意义(P<0.05)。术后2年随访,优76.06%,良16.41%,中6.28%,差1.25%;支架通畅率88.62%。

结论

LEDVT腔内治疗,能尽早清除深静脉主干血栓,迅速恢复血流,缩短病程,近、中期疗效显著。

Objective

To investigate the clinical effect of endovascular therapy for acute lower extremity deep venous thrombosis(LEDVT).

Methods

The clinical data of 1068 patients treated from January 2000 to December 2010 were analysed retrospectively. There were 311 cases of central type, 549 mixed type and 208 calf DVT. Foot dorsal vein and femoral vein were punctured to obtain venogram respectively. An Inferior vena cava filter was prophylactic placed. Then mechanical aspiration thrombectomy was performed via ipsilateral vein; patients with stenosis(>50% ) or obstruction of iliac vein underwent venoplasty and stent placement. Residual thrombus underwent thrombolytic treatment postoperatively. Patients received endovascular therapy were given a short-term and medium-term follow-up evaluation.

Results

The rate of thrombus removal was GradeⅠ65.45%, GradeⅡ25.75%, GradeⅢ 8.05%, Grade Ⅳ 0.75%, respectively. Total effective rate was 99.25%. Postprocedure 24 months follow-up, "Excellent" 76.06% , "Moderate" 16.41% , "Mild" 6.28%, "Poor" 1.25%. The stent patency rate was 88.62%.

Conclusion

Endovascular therapy for acute LEDVT, which can remove thrombus as soon as possible, restore the blood flow instantly, and shorten hospitalization, has a notable short- and medium-term clinical effect.

表1 1068例急性LEDVT患者不同分型的近期临床治疗效果以及血栓清除分级比较
图1 典型病例,男性,49岁,左髂静脉闭塞合并急性混合型下肢深静脉血栓形成
图2 492例髂静脉闭塞合并急性混合型下肢深静脉血栓形成(A-H),如箭头所示
表2 1036例LEDVT患者术后2年随访结果[例(﹪)]
图3 Kaplan-Meier法分析281例中央型和211例混合型支架植入患者术后通畅率
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