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浙江大学学报（医学版）
浙江大学学报（医学版）  2018, Vol. 47 Issue (6): 595-600    DOI: 10.3785/j.issn.1008-9292.2018.12.05
专题报道     
经皮机械血栓清除联合球囊血管成形治疗髂股静脉血栓形成患者疗效分析
林作栋(),郎德海*()
宁波市第二医院血管外科, 浙江 宁波 315010
Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis
LIN Zuodong(),LANG Dehai*()
Department of Vascular Surgery, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang Province, China
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摘要：

目的: 评价经皮机械血栓清除（PMT）联合球囊血管成形（PTA）治疗髂股静脉血栓形成患者的临床疗效。方法: 回顾性分析2015年11月至2017年12月于宁波市第二医院血管外科住院治疗的94例髂股静脉血栓形成患者的临床资料，根据吸栓前是否联合PTA分为PMT+PTA组（50例）和单纯PMT组（44例），比较两组的疗效，下腔静脉滤器取出及栓塞情况，治疗前后血清肌酐、乳酸脱氢酶、血红蛋白的变化，以及症状性肺栓塞、腘窝穿刺点出血等并发症的发生情况。结果: 所有患者均顺利完成手术。PMT+PTA组平均血栓清除率较单纯PMT组高，吸栓时间较PMT组短（均P < 0.01），但两组间髂股静脉狭窄率、支架植入率及辅助导管直接溶栓率差异均无统计学意义（均P>0.05）。两组下腔静脉滤器取出率分别为82.0%（41/50）和81.8%（36/44），差异无统计学意义（P>0.05）。两组术后血清肌酐、乳酸脱氢酶、血红蛋白变化差异均无统计学意义（均P>0.05）。PMT+PTA组术后发生症状性肺栓塞1例（2.0%），腘窝穿刺点出血2例（4.0%）；单纯PMT组未发现症状性肺栓塞者，腘窝穿刺点出血的发生率为4.5%（2/44），与PMT+PTA组差异无统计学意义（P>0.05）。结论: PMT联合PTA治疗髂股静脉血栓形成不仅缩短了吸栓时间、血栓清除效果更好，同时不增加肺栓塞发生率，值得临床推广应用。
关键词： 静脉血栓形成/治疗;  股静脉;  髂静脉;  血栓切除术;  气囊扩张术;  综合疗法;  治疗结果    
Abstract:

Objective: To evaluate the clinical efficacy of percutaneous mechanical thrombectomy (PMT) combined with percutaneous transluminal angioplasty (PTA) in the treatment of iliofemoral deep vein thrombosis. Methods: Ninety-four patients with iliofemoral deep vein thrombosis were identified in this retrospective study in our institution from November 2015 through December 2017. Patients were divided into two groups:PMT+PTA group (n=50) and PMT only group (n=44). Clot lysis rates, the retrieving and the embolism of the interior vena cava filter, as well as the incidence of complications were compared between two groups. The changes of serum creatinine, lactate dehydrogenase and hemoglobin were also measured perioperatively. Results: All procedures were completed successfully. The average clot lysis rate was higher and the procedure time was shorter in PMT+PTA group than those in PMT group (both P < 0.01). No significant differences were found in the rates of venous stenosis, catheter-directed thrombolysis and stent placement between two groups (all P>0.05). The interior vena cava filter was taken out in 82.0% (41/50) patients of PMT+PTA group and 81.8% (36/44) patients of PMT group (P>0.05). There were no significant differences of the changes in serum creatinine, lactate dehydrogenase and hemoglobin (all P>0.05). In PMT+PTA group, symptomatic pulmonary embolism and puncture bleeding occurred in 1(2.0%) and 2(4.0%) patients, while in PMT group, it was 0 and 2(4.5%), respectively (P>0.05). Conclusion: PMT combined with PTA is more effective than PMT alone for the treatment of iliofemoral deep vein thrombosis with less procedure time and without more incidence of pulmonary embolism.
Key words: Venous thrombosis/therapy    Femoral vein    Iliac vein    Thrombectomy    Balloon dilatation    Combined modality therapy    Treatment outcome
收稿日期: 2018-07-05 出版日期: 2019-03-15
:  R654  
基金资助: 宁波市医疗卫生品牌学科-临床医学共建（心脏大血管诊疗中心）(PPXK2018-01)
通讯作者: 郎德海     E-mail: linzuodong1989@163.com;13738868758@139.com
作者简介: 林作栋(1989-), 男, 硕士, 主治医师, 主要从事外周血管介入相关临床研究; E-mail:linzuodong1989@163.com; https://orcid.org/0000-0002-8120-2872
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林作栋
郎德海

引用本文:

林作栋,郎德海. 经皮机械血栓清除联合球囊血管成形治疗髂股静脉血栓形成患者疗效分析[J]. 浙江大学学报（医学版）, 2018, 47(6): 595-600.

LIN Zuodong,LANG Dehai. Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis. J Zhejiang Univ (Med Sci), 2018, 47(6): 595-600.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.12.05    或    http://www.zjujournals.com/med/CN/Y2018/V47/I6/595

[$\bar x \pm s$或n(%)]
组别 n 年龄(岁) 性别(男/女) 病程(d) 患肢侧(左/右) 吸烟史 高血压史 糖尿病史 肿瘤史 手术史 同侧血栓史 术前血清肌酐(μmol/L) 术前乳酸脱氢酶(IU/L) 术前血栓评分
—：无相关数据; PMT：经皮机械血栓清除；PTA：球囊血管成形.
单纯PMT组 44 59±14 21/23 6±3 39/5 11(25.0) 17(38.6) 4(9.0) 5(11.4) 13(29.5) 5(11.4) 69±27 229±60 10.7±2.6
PMT+PTA组 50 62±17 15/35 8±6 47/3 9(18.0) 20(40.0) 5(10.0) 5(10.0) 14(28.0) 7(14.0) 62±17 235±57 10.3±2.4
t/χ2值 — 0.706 3.112 1.112 0.865 0.685 0.018 0.220 0.046 0.324 0.146 -1.246 0.452 0.194
P值 — ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 1  两组患者基线资料比较
[$\bar x \pm s$或n(%)]
组别 n 吸栓时间(s) 血栓清除率(%) 血栓清除程度(Ⅰ/Ⅱ/Ⅲ) 髂股静脉狭窄 支架植入 辅助导管直接溶栓
—：无相关数据；PMT：经皮机械血栓清除术；PTA：球囊血管成形术.
单纯PMT组 44 282±95 77±15 1/35/8 35(79.5) 34(77.3) 28(63.6)
PMT+PTA组 50 223±74 87±11 0/36/14 45(90.0) 43(86.0) 34(68.0)
t/χ2值 — －3.408 3.589 2.277 2.018 1.203 0.198
P值 — ＜0.01 ＜0.01 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 2  两组治疗结果比较
图 1  典型病例经皮机械血栓清除联合球囊血管成形治疗前后静脉造影图像
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