Please wait a minute...
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
 全文: PDF(1265 KB)   HTML( 5 )
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
服务  
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章  
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        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 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 >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 -3.408 3.589 2.277 2.018 1.203 0.198
P <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
1 COMEROTA A J , GREWAL N , MARTINEZ J T et al. Post thrombotic morbidity correlates with residual thrnmbus following catheter-directed thrombolysis for iliofemoral deep vein thrombosis[J]. J Vasc Surg, 2012, 55 (3): 768- 773
doi: 10.1016/j.jvs.2011.10.032
2 LIN P H , ZHOU W , DARDIK A et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis[J]. Am J Surg, 2006, 192 (6): 782- 788
doi: 10.1016/j.amjsurg.2006.08.045
3 MEWISSEN M W , SEABROOK G R , MEISSNER M H et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis:report of a national multicenter registry[J]. Radiology, 1999, 211 (1): 39- 49
4 KIM H S , PATRA A , PAXTON B E et al. Adjunctive percutaneous mechanical thrombectomy for lower-extremity deep vein thrombosis:clinical and economic outcomes[J]. J Vasc Interv Radiol, 2006, 17 (7): 1099- 1104
doi: 10.1097/01.RVI.0000228334.47073.C4
5 KIM H S , PATRA A , PAXTON B E et al. Catheter-directed thrombolysis with percutaneous rheolytic thrombectomy versus thrombolysis alone in upper and lower extremity deep vein thrombosis[J]. Cardiovasc Intervent Radiol, 2006, 29 (6): 1003- 1007
doi: 10.1007/s00270-005-0341-4
6 GARCIA M J , LOOKSTEIN R , MALHOTRA R et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy:final report of the prospective multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) registry[J]. J Vasc Interv Radiol, 2015, 26 (6): 777- 785
doi: 10.1016/j.jvir.2015.01.036
7 MORROW K L , KIM A H , PLATO S A et al. Increased risk of renal dysfunction with percutaneous mechanical thrombectomy compared with catheter-directed thrombolysis[J]. J Vasc Surg, 2017, 65 (5): 1460- 1466
doi: 10.1016/j.jvs.2016.09.047
8 李智, 倪才方, 金泳海 et al. 球囊扩张辅助经导管直接溶栓治疗急性下肢深静脉血栓[J]. 中华放射学杂志, 2012, 46 (6): 561- 566
LI Zhi , NI Caifang , JIN Yonghai et al. Balloon-assisted catheter directed thrombolysis for acute lower extremity deep vein thrombosis[J]. Chinese Journal of Radiology, 2012, 46 (6): 561- 566
doi: 10.3760/cma.j.issn.1005-1201.2012.06.018
9 黄献琛, 陈万海, 李春荣 et al. 介入治疗急性左髂股静脉血栓——先溶栓或先扩张[J]. 介入放射学杂志, 2011, 20 (9): 688- 691
HUANG Xianchen , CHEN Wanhai , LI Chunrong et al. Thrombolysis together with vascular dilatation for the treatment of acute left iliofemoral venous thrombosis:which procedure should be carried out first?[J]. Journal of Interventional Radiology, 2011, 20 (9): 688- 691
doi: 10.3969/j.issn.1008-794X.2011.09.006
10 《血管与腔内血管外科杂志》编辑部, 下肢静脉疾病外科治疗专家协作组 . AngioJet机械血栓清除术治疗急性下肢深静脉血栓形成的专家共识(2016版)[J]. 血管与腔内血管外科杂志, 2017, 3 (1): 555- 558
Editorial department of Journal of Vascular and Endovascular Surgery , The panel of Venous diseases of lower extremity surgical treatment specialists . Recommendations of percutaneous mechanical thrombectomy in the treatment of acute deep vein thrombosis of lower extremity(2016 Edition)[J]. Journal of Vascular and Endovascular Surgery, 2017, 3 (1): 555- 558
11 PORTER J M , MONETA G L . Reporting standards in venous disease:an update. International consensus committee on chronic venous disease[J]. J Vasc Surg, 1995, 21 (4): 635- 645
doi: 10.1016/S0741-5214(95)70195-8
12 ARSLAN B , TURBA U C , MATSUMOTO A H . Acute renal failure associated with percutaneous mechanical thrombectomy for iliocaval venous thrombosis[J]. Semin Intervent Radiol, 2007, 24 (3): 288- 295
doi: 10.1055/s-2007-985736
[1] 王晓辉,何杨燕,吴子衡,张鸿坤. 一体化微创手术治疗髂静脉压迫综合征伴下肢静脉曲张患者疗效观察[J]. 浙江大学学报(医学版), 2018, 47(6): 577-582.
[2] 余钻标,林作栋,郎德海. 经皮机械血栓清除联合支架植入治疗急性髂股静脉血栓形成患者中远期疗效评估[J]. 浙江大学学报(医学版), 2018, 47(6): 623-627.
[3] 沈宏,季峰. 无X射线监视内镜下消化道支架置入治疗消化道狭窄的疗效和安全性[J]. 浙江大学学报(医学版), 2018, 47(6): 643-650.
[4] 尹孝亮,郎德海,王迪. 经皮机械血栓清除治疗急性髂股静脉血栓形成患者疗效观察[J]. 浙江大学学报(医学版), 2018, 47(6): 588-594.
[5] 邓璇,何寒青,周洋,潘金仁,严睿,唐学雯,符剑. 水痘疫苗不同免疫策略的卫生经济学评价[J]. 浙江大学学报(医学版), 2018, 47(4): 374-380.
[6] 徐玮泽,叶菁菁,李建华,张泽伟,俞建根,石卓,俞劲,舒强. 单纯食管超声心动图引导经皮房间隔缺损封堵术治疗房间隔缺损患儿的疗效[J]. 浙江大学学报(医学版), 2018, 47(3): 244-249.
[7] 张玉喜,莫绪明,孙剑,彭卫,戚继荣,武开宏,束亚琴. 胸腔镜手术治疗Ⅲ型食管闭锁合并气管食管瘘新生儿的疗效[J]. 浙江大学学报(医学版), 2018, 47(3): 266-271.
[8] 张士松,武玉睿,刘红真,翟允鹏,刘威. 复杂型先天性肠闭锁患儿治疗体会[J]. 浙江大学学报(医学版), 2018, 47(3): 255-260.
[9] 吕成杰,胡东来,黄寿奖,秦琪,赵晓霞,胡书奇,张雅楠,方旋,郭晓东,钭金法. 经脐单部位腹腔镜手术治疗新生儿先天性十二指肠梗阻的疗效和安全性观察[J]. 浙江大学学报(医学版), 2018, 47(3): 261-265.
[10] 祝子逸,郦志军,何正富,王云震. 内镜引导下吻合口瘘冲洗治疗食管胃吻合口瘘合并瘘旁脓肿临床疗效观察[J]. 浙江大学学报(医学版), 2017, 46(6): 637-642.
[11] 陆薇,林梦娜,赵士芳,王慧明,何福明. 改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者临床观察[J]. 浙江大学学报(医学版), 2017, 46(6): 630-636.
[12] 张思影 等. CT和磁共振参数反应图在肿瘤精准疗效评估中的研究进展[J]. 浙江大学学报(医学版), 2017, 46(5): 468-472.
[13] 潘静颖 等. PET-CT与乳腺癌分子病理分型、治疗反应及预后的相关性研究进展[J]. 浙江大学学报(医学版), 2017, 46(5): 473-480.
[14] 邹丽霞 等. 人源化白细胞介素-6受体抗体治疗全身型幼年特发性关节炎的疗效及安全性[J]. 浙江大学学报(医学版), 2017, 46(4): 421-426.
[15] 张美霞 等. 静脉溶栓获益的最大梗死体积阈值与急性缺血性卒中患者发病时间的关系[J]. 浙江大学学报(医学版), 2017, 46(4): 384-389.