CatheterDirected Thrombolysis for Patients with Acute Deep Vein Thrombosis of Lower Limb (Report of 28 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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徐貴云 , 蔣厚文 , 郝立俊 , 陳闖

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Keywords：

深靜脈血栓形成; 抗凝; 導管溶栓; 腘靜脈; 下腔靜脈濾器

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目的探討經腘靜脈置溶栓導管灌注溶栓治療急性下肢深靜脈血栓形成（DVT）的臨床應用價值。方法對28例急性DVT患者（其中2例合并肺動脈栓塞）在超聲引導下經患肢腘靜脈穿刺置入溶栓導管至髂、股靜脈血栓中進行溶栓治療，并對溶栓效果進行分析。結果全組患者溶栓后癥狀明顯改善，下肢腫脹消退，肺部癥狀緩解。溶栓后患、健側大腿周徑差〔(1.72±1.23) cm〕明顯小于溶栓前〔(5.47±1.29) cm〕,差異有統計學意義(t=12.14，P lt;0.01)，患肢大腿消腫率為91.58%; 溶栓后患、健側小腿周徑差〔(1.55±0.77) cm〕也明顯小于溶栓前〔(5.04±1.32) cm〕，差異有統計學意義（t=13.81，P lt;0.01)，患肢小腿消腫率為84.92%。溶栓后靜脈通暢評分〔(4.34±3.55)分〕明顯低于溶栓前〔(15.23±4.64) 分〕，差異有統計學意義(t=6.42，P lt;0.01 )，溶栓后靜脈平均通暢率為87.43%。 2例合并肺動脈栓塞患者中，1例栓子完全溶解，1例大部分溶解。所有患者均無嚴重并發癥。 25例患者獲隨訪，隨訪1～12個月（平均7.16個月），無一例出現血栓再發。結論經腘靜脈置管溶栓治療急性DVT是一種安全、有效的治療方法。

Citation： 徐貴云,蔣厚文,郝立俊,陳闖. CatheterDirected Thrombolysis for Patients with Acute Deep Vein Thrombosis of Lower Limb (Report of 28 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(2): 204-206. doi: Copy

1.	劉咸羅, 錢小星, 湯永勝, 等. 急性下肢深靜脈血栓形成的實驗與臨床研究 [J]. 中國現代普通外科進展, 2009, 12(4): 317320.
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5.	張柏根. 下肢深靜脈血栓形成治療和預后的幾個問題 [J]. 中華普通外科雜志, 2006, 21(2): 8183.
6.	Baldwin ZK, Comerota AJ, Schwartz LB. Catheterdirected thrombolysis for deep venous thrombosis [J]. Vasc Endovascular Surg, 2004, 38(1): 19.
7.	鄭江華, 武國, 朱彥彬，等. 腔靜脈濾器置入聯合導管直接溶栓治療下肢深靜脈血栓形成臨床分析 [J]. 中國普外基礎與臨床雜志, 2010, 17(7): 679682.
8.	Mewissen MW, Seabrook GR, Meissner MH, et al. Catheterdirected thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry [J]. Radiology, 1999, 211(1): 3949.
9.	張精勇, 金星, 吳學君, 等. 濾器保護下置管溶栓治療下肢深靜脈血栓形成臨床總結 [J]. 中國實用外科雜志, 2006, 26(10): 774776.
10.	Greenfield LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters [J]. J Vasc Surg, 2001, 33(3): 510514.
11.	Harenberg J. Fixeddose versus adjusteddose low molecular weight heparin for the initial treatment of patients with deep venous thrombosis [J]. Curr Opin Pulm Med, 2002, 8(5): 383388.
12.	Alesh I, Kayali F, Stein PD. Catheterdirected thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review [J]. Catheter Cardiovasc Interv, 2007, 70(1): 143148.
13.	李國劍, 楊國凱, 何曉明, 等. 下腔靜脈濾器在治療下肢深靜脈血栓中的應用 [J]. 中國普外基礎與臨床雜志, 2009, 16(11): 922924.

1. 劉咸羅, 錢小星, 湯永勝, 等. 急性下肢深靜脈血栓形成的實驗與臨床研究 [J]. 中國現代普通外科進展, 2009, 12(4): 317320.
2. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease [J]. J Vasc Surg, 1995, 21(4): 635645.
3. Hamilton W. Malignancy and deep vein thrombosis [J]. Br J Gen Parct, 2006, 56(532): 886.
4. Segal JB, Streiff MB, Hofmann LV, et al. Management of venous thromboembolism: a systematic review for a practice guideline [J]. Ann Intern Med, 2007, 146(3): 211222.
5. 張柏根. 下肢深靜脈血栓形成治療和預后的幾個問題 [J]. 中華普通外科雜志, 2006, 21(2): 8183.
6. Baldwin ZK, Comerota AJ, Schwartz LB. Catheterdirected thrombolysis for deep venous thrombosis [J]. Vasc Endovascular Surg, 2004, 38(1): 19.
7. 鄭江華, 武國, 朱彥彬，等. 腔靜脈濾器置入聯合導管直接溶栓治療下肢深靜脈血栓形成臨床分析 [J]. 中國普外基礎與臨床雜志, 2010, 17(7): 679682.
8. Mewissen MW, Seabrook GR, Meissner MH, et al. Catheterdirected thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry [J]. Radiology, 1999, 211(1): 3949.
9. 張精勇, 金星, 吳學君, 等. 濾器保護下置管溶栓治療下肢深靜脈血栓形成臨床總結 [J]. 中國實用外科雜志, 2006, 26(10): 774776.
10. Greenfield LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters [J]. J Vasc Surg, 2001, 33(3): 510514.
11. Harenberg J. Fixeddose versus adjusteddose low molecular weight heparin for the initial treatment of patients with deep venous thrombosis [J]. Curr Opin Pulm Med, 2002, 8(5): 383388.
12. Alesh I, Kayali F, Stein PD. Catheterdirected thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review [J]. Catheter Cardiovasc Interv, 2007, 70(1): 143148.
13. 李國劍, 楊國凱, 何曉明, 等. 下腔靜脈濾器在治療下肢深靜脈血栓中的應用 [J]. 中國普外基礎與臨床雜志, 2009, 16(11): 922924.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

CatheterDirected Thrombolysis for Patients with Acute Deep Vein Thrombosis of Lower Limb (Report of 28 Cases)

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