切换至 "中华医学电子期刊资源库"

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]. 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]. 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
1
罗定远,黎洪浩,龙淼云, 等. 手术取栓与药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效比较. 中华普通外科杂志, 2010,25(11): 876-879.
2
Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome:a randomized, controlled trial. Ann Intern Med, 2004, 141(4): 249-256.
3
谷涌泉,张建,齐立行, 等. 急性重症下肢深静脉血栓形成的外科治疗. 中华医学杂志, 2009, 89(45): 3186-3188.
4
Kwak HS, Han YM, Lee YS, et al. Stents in common iliac vein obstruction with acute ipsilateral deep venous thrombosis: early and late results. Vasc Interv Radiol, 2005, 16(6): 815-822.
5
董国祥. 进一步提高我国下肢静脉瓣膜功能不全的治疗水平[J/CD]. 中华普通外科学文献:电子版, 2008, 2(5): 1-3.
6
顾建平,何旭楼,文胜, 等. 经腘静脉穿刺介入治疗髂股静脉阻塞. 中华放射学杂志, 2005, 39(9): 921-924.
7
Spencer FA, Kroll A, Lessard D, et al. Isolated calf deep vein thrombosis in the community setting: the Worcester Venous Thromboembolism study. J Thromb Thrombolysis, 2012, 33(3): 211-217.
8
顾建平,徐克,滕高军.下肢深静脉血栓形成介入治疗规范的专家共识. 介入放射学杂志, 2011, 20(7): 505-510.
9
Krupski WC, Bass A, Dilley RB, et al. Propagation of deep venous thrombosis identified by duplex ultrasonography. J Vasc Surg, 1990, 12(4): 467-475.
10
Patel NH, Stookey KR, Ketcham DB, et al. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol, 2000, 11(10): 1297-1302.
11
Lamont JP, Pearl GJ, Patetsios P, et al. Prospective evaluation of endoluminal venous stents in the treatment of the May–Thurner syndrome. Ann Vasc Surg, 2002, 16(1): 61-64.
12
贾鑫,郭伟. 下肢动脉腔内治疗,循证之路有多远?[J/CD].中华临床医师杂志:电子版, 2012, 6(1): 161-163.
13
Enden T, Sandvik L, Klw NE, et al. Catheter-directed venous thrombolysis in acute iliofemoral vein thrombosis- the CaVenT study: rationale and design of a multicenter,randomized,controlled, clinical trial(NCT00251771). Am Heart J, 2007, 154(5): 808-814.
[1] 魏小勇. 原发性肝癌转化治疗焦点问题探讨[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 602-607.
[2] 宋碧萱, 郭海川, 韩子钰, 周瑞娟, 李承思, 姬晨妮. 开放式楔形胫骨高位截骨术后下肢深静脉血栓形成的危险因素分析及预测列线图的构建[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 226-232.
[3] 刘中百, 任勇军. 肝细胞癌的介入治疗现状及进展[J]. 中华消化病与影像杂志(电子版), 2023, 13(02): 111-115.
[4] 郑景达, 黄金旗, 张庆贤, 陈煌, 高晓杰. 小腿深静脉入路AngioJet一站式血栓清除治疗全肢型急性下肢深静脉血栓形成患者的临床研究[J]. 中华介入放射学电子杂志, 2023, 11(04): 305-309.
[5] 李世凯, 梁佳, 何艳艳, 于毅, 李天晓, 常金龙, 贺迎坤. 兔颈动脉粥样硬化性狭窄模型在介入治疗的应用进展[J]. 中华介入放射学电子杂志, 2023, 11(04): 357-362.
[6] 张德伟, 雷毅, 江哲宇, 王黎洲, 许国辉, 周石. 杂交手术治疗下肢深静脉血栓合并下肢急性动脉血栓一例[J]. 中华介入放射学电子杂志, 2023, 11(04): 380-384.
[7] 林加文, 印于, 杨俊, 朱晓黎, 王万胜. 肝动门静脉瘘合并腹水一例[J]. 中华介入放射学电子杂志, 2023, 11(03): 289-291.
[8] 吴雅琴, 莫伟, 向华, 李琴, 李兰. 肝癌患者介入治疗穿刺处出血影响因素的真实世界研究[J]. 中华介入放射学电子杂志, 2023, 11(02): 117-122.
[9] 曾嘉, 何东风. 介入栓塞材料在肝癌治疗中的研究进展[J]. 中华介入放射学电子杂志, 2023, 11(01): 62-67.
[10] 张正宇, 谢兴武, 周雪惠, 陈光斌. DSA引导下经皮动脉栓塞治疗腹壁下动脉出血一例[J]. 中华介入放射学电子杂志, 2023, 11(01): 82-83,88.
[11] 周璐, 王庆, 兰斌. 介入治疗医源性髂动静脉瘘一例[J]. 中华介入放射学电子杂志, 2023, 11(01): 84-88.
[12] 陈丹丹, 潘文志, 陈莎莎, 张源, 张晓春, 李明飞, 周达新, 葛均波. 结构性心脏病年度报告2022[J]. 中华心脏与心律电子杂志, 2023, 11(03): 129-140.
[13] 孙相利, 许真真. 经皮冠状动脉旋磨术在冠状动脉重度钙化病变介入治疗中的应用[J]. 中华老年病研究电子杂志, 2023, 10(02): 33-36.
[14] 姜新鹏, 李晓明, 杨航, 宫一宸, 傅元豪, 傅瑜, 张喆. 单纯经胸超声心动图引导卵圆孔未闭封堵术早期安全性及有效性分析[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 320-324.
[15] 连万成, 姚京, 吴泽涛, 何毅, 伍健明, 张猛. 血流导向装置治疗颅内未破裂动脉瘤的疗效与影响因素分析[J]. 中华脑血管病杂志(电子版), 2023, 17(01): 31-36.
阅读次数
全文


摘要