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目的评估导管接触溶栓(CDT)治疗急性和亚急性下肢深静脉血栓形成(DVT)的临床疗效。方法回顾性分析2012年3月至2017年5月扬州大学附属医院血管外科收治的40例DVT患者的临床资料,其中CDT组17例,外周静脉溶栓组23例,比较2组患者治疗前后患肢和健肢的大、小腿周径差,患肢消肿率,患肢静脉通畅度评分,溶栓后患肢的静脉通畅率;随访1～62个月,根据Villalta评分对治疗后患者血栓形成后综合征(PTS)的发生做出诊断。结果 40例患者的肢体肿胀均不同程度消退,无出血、肺栓塞(PE)、感染、血栓复发等并发症。2组患者治疗后大腿和小腿健、患侧的肢体周径差明显小于治疗前,CDT组比静脉溶栓组更明显;2组患者治疗后造影复查显示,静脉通畅评分比治疗前明显减小,CDT组比静脉溶栓组更明显;随访结果显示,CDT组与静脉溶栓组患者的Villalta评分分别为(3.06±0.78)分、(4.22±0.61)分,2组比较差异有统计学意义(P<0.05);PTS发生率分别为(2/17,11.76%)、(6/23,26.09%),静脉溶栓组高于CDT组,差异有统计学意义(P<0.05)。结论 CDT治疗急性、亚急性下肢DVT,创伤小、疗效明显、安全性高,值得在临床进一步推广。
Objective To evaluate the clinical efficacy of catheterized thrombolysis (CDT) in the treatment of acute and subacute deep vein thrombosis (DVT). Methods The clinical data of 40 DVT patients admitted to Department of Vascular Surgery, Affiliated Hospital of Yangzhou University from March 2012 to May 2017 were retrospectively analyzed. Among them, 17 cases were in CDT group and 23 cases were in peripheral venous thrombolysis group. Before and after treatment, Limbs and healthy limbs, poor diameter of the leg, limb swelling, limb vein patency score, thrombolysis limb vein patency rate; follow-up of 1 to 62 months, according to Villalta score after treatment of patients with thrombosis Post-formation syndrome (PTS) is diagnosed. Results The limb swelling of 40 patients subsided to varying degrees without complications of hemorrhage, pulmonary embolism (PE), infection, and recurrence of thrombus. The difference of limb circumference between thigh and calf in both groups was significantly less than that before treatment in the CDT group after treatment. The venous patency score of the two groups was significantly lower than that before treatment , And CDT group was more obvious than intravenous thrombolysis group. The follow-up results showed that Villalta score of CDT group and intravenous thrombolysis group were (3.06 ± 0.78) and (4.22 ± 0.61) points, respectively, with significant difference between the two groups (P <0.05). The incidence of PTS was (2/17, 11.76%), (6 / 23,26.09%) higher than that in CDT group, the difference was statistically significant (P <0.05). Conclusions CDT is effective in treating acute and subacute DVT of lower extremity with obvious curative effect and high safety. It is worth further clinical application.