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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): 588-594    DOI: 10.3785/j.issn.1008-9292.2018.12.04
专题报道     
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
尹孝亮(),郎德海*(),王迪
宁波市第二医院血管外科, 浙江 宁波 315010
Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis
YIN Xiaoliang(),LANG Dehai*(),WANG Di
Department of Vascular Surgery, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang Province, China
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摘要：

目的: 探讨经皮机械血栓清除（PMT）或联合导管直接溶栓（CDT）与单纯CDT治疗急性髂股静脉血栓形成的临床效果。方法: 回顾性分析宁波市第二医院血管外科2015年9月至2017年9月采用PMT和CDT治疗急性髂股静脉血栓形成患者的临床资料。PMT组94例采用AngioJet机械血栓清除系统，若血栓残留则联合CDT治疗；CDT组76例单纯行CDT治疗；两组血栓清除后若存在髂静脉狭窄则联合腔内血管成形术。评估并比较两组的血栓清除程度及安全性。结果: PMT组血栓清除程度达Ⅲ级86例（91.5%），Ⅱ级5例（5.3%），Ⅰ级3例（3.2%）；CDT组血栓清除程度达Ⅲ级63例（82.9%），Ⅱ级7例（9.2%），Ⅰ级6例（7.9%），两组差异无统计学意义（P>0.05）。两组患者经治疗后下肢肿胀症状均得到有效缓解，双下肢膝上15 cm周径差分别为（2.3±0.9）cm和（2.5±1.1）cm（P>0.05）。PMT组溶栓时间较CDT组缩短[（2.6±1.2）d与（5.3±1.5）d，P < 0.05]，尿激酶用量减少[（15.0±5.0）×105U与（26.5±7.5）×105U，P < 0.05]。PMT组术后血红蛋白下降（10.2±4.6）g/L，下降幅度较CDT组增加（P < 0.01）。随访期间，两组患者血栓复发及血栓形成后综合征的发生率差异均无统计学意义（均P>0.05）。结论: PMT与CDT治疗急性髂股静脉血栓形成均有很好的血栓清除效果，且PMT溶栓时间短、尿激酶用量少，安全可靠。
关键词： 血栓溶解疗法/方法;  导管插入术;  支架;  髂静脉;  急性病;  静脉血栓形成;  下肢/血液供给;  治疗结果    
Abstract:

Objective: To compare the efficacy of mechanical thrombectomy with transcatheter thrombolysis in the treatment of acute iliac femoral venous thrombosis. Methods: The clinical data of 170 patients with acute iliac venous thrombosis treated in Ningbo No.2 Hospital from September 2015 to September 2017 were retrospectively reviewed. Among them, 94 cases were treated with AngioJet mechanical thrombolysis or additional thrombolysis for residual thrombus (PMT group) and 76 cases were treated with catheter-directed thrombolysis(CDT group). After thrombolytic treatment if there was stenosis of iliac vein, the transluminal angioplasty was also performed. The clearance of thrombus and safety were evaluated and compared between two groups. Results: In PMT group there were 86 cases (91.5%) with grade Ⅲ, 5 cases (5.3%) with grade Ⅱ, 3 cases (3.2%) with grade Ⅰ clearance of thrombus; while in CDT group, there were 63 cases (82.9%) with grade Ⅲ, 7 cases (9.2%) with grade Ⅱ and 6 cases (7.9%) with grade Ⅰ clearance of thrombus (P>0.05). The differences of diameter of two lower extremities 15 cm above knee after treatment in PMT and CDT groups were (2.3±0.9) cm and (2.5±1.1) cm, respectively (P>0.05). The time of thrombolysis in group PMT was significantly shorter than that in group CDT[(2.6±1.2) d vs. (5.3±1.5) d, P < 0.05]. The dosage of urokinase in PMT group was significantly lower than that in CDT group[(15.0±5.0)×105 U vs. (26.5±7.5)×105 U, P < 0.05]. Hemoglobin decrease was observed in both groups, which was more significant in PMT group (P < 0.01). During the following period, there was no significant difference in the incidence of recurrence and post-thrombosis syndrome in two groups (all P>0.05). Conclusion: Both PMT and CDT have good thrombus clearance effect in the treatment of acute iliac femoral venous thrombosis, however, PMT has the advantages of short thrombolytic time and less urokinase.
Key words: Thrombolytic therapy/methods    Catheterization    Stents    Iliac vein    Acute disease    Venous thrombosis    Lower extremity/blood supply    Treatment outcome
收稿日期: 2018-06-29 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);宁波市第二医院重点学科项目(2016-57);宁波市第二医院华美科研基金(2018HMKY56)
通讯作者: 郎德海     E-mail: sundryxl@163.com;13738868758@139.com
作者简介: 尹孝亮(1988-), 男, 硕士, 住院医师, 主要从事外周血管疾病的临床及基础研究; E-mail:sundryxl@163.com; https://orcid.org/0000-0001-9268-9527
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尹孝亮
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引用本文:

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.

YIN Xiaoliang,LANG Dehai,WANG Di. Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis. J Zhejiang Univ (Med Sci), 2018, 47(6): 588-594.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.12.04    或    http://www.zjujournals.com/med/CN/Y2018/V47/I6/588

图 1  急性髂股静脉血栓形成患者经皮机械血栓清除联合导管直接溶栓治疗静脉造影图像
($\bar x \pm s$或n)
组别 n 年龄(岁) 性别(男/女) 病程(d) 患肢侧(左/右) 健肢与患肢膝上15 cm周径差(cm)
—：无相关数据; PMT：经皮机械血栓清除术；CDT：导管直接溶栓术.
PMT组 94 62±14 47/47 3.4±1.6 78/16 6.0±2.8
CDT组 76 59±14 36/40 3.7±1.5 64/12 6.4±3.0
t/χ2值 — 1.39 0.12 1.25 0.05 0.90
P值 — ＞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 血栓清除时间(d) 尿激酶用量(105U) 健肢与患肢膝上15 cm周径差(cm) 住院时间(d) 支架植入例数 血栓清除程度
Ⅲ级 Ⅱ级 Ⅰ级
“—”：无相关数据；PMT:经皮机械血栓消除术；CDT:导管直接溶栓术.
PMT组 94 2.6±1.2 15.0±5.0 2.3±0.9 11.2±4.0 67(71.3) 86(91.5) 5(5.3) 3(3.2)
CDT组 76 5.3±1.5 26.5±7.5 2.5±1.1 14.0±4.3 33(43.4) 63(82.9) 7(9.2) 6(7.9)
t/χ2值 — 13.0 11.9 1.3 4.4 13.5 2.9 1.0 1.0
P值 — ＜0.01 ＜0.01 ＞0.05 ＜0.01 ＜0.01 ＞0.05 ＞0.05 ＞0.05
表 2  两组治疗结果比较
[$\bar x \pm s$或n(%)]
组别 n 围手术期并发症 血栓复发 血栓形成后综合征 滤器取出
血红蛋白下降幅度(g/L) 血红蛋白尿 出血 迷走神经反射 血小板数减少
“—”：无相关数据；PMT:经皮机械血栓消除术；CDT:导管直接溶栓术；*6例原滤器放置后未取再发血栓形成的患者未计入.
PMT组 94 10.2±4.6 85(90.4) 3(3.2) 9(9.6) 0(0.0) 4(4.3) 8(8.5) 72(76.6)
CDT组 76 6.8±3.0 5(6.6) 7(9.2) 2(2.6) 2(2.6) 3(3.9) 9(11.8) 51(72.9)*
t/χ2值 — 5.6 118.6 1.8 2.3 0.8 0.1 0.5 1.9
P值 — ＜0.01 ＜0.01 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 3  两组并发症发生情况比较
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