药物机械偶联式血栓清除治疗急性左髂股静脉血栓形成的近期疗效
| 作者: |
1闫振华,
2曲立峰,
2王瑞华,
2刘兆轩,
3郭信,
1张冠一,
2孟庆义,
3陆信武
1 潍坊医学院临床医学院，山东 潍坊 261053 2 山东大学附属济南市中心医院 血管外科，山东 济南 250013 3 上海交通大学医学院附属第九人民医院 血管外科，上海 200011 |
| 通讯: |
孟庆义
Email: 1543864012@qq.com |
| DOI: | 10.3978/.2017.12.012 |
| 基金: | 中国博士后科学基金资助项目（ 2016M591690）；山东省济南市科学技术发展计划基金资助项目（ 201704134）。 |
摘要
目的：探讨药物机械偶联式血栓清除（AngioJet血栓清除系统）治疗急性左髂股静脉血栓形成的近期疗效。
方法：回顾性分析2016年1月—2017年4月期间两个血管外科中心连续收治的38例急性左髂股静脉血栓形成（病程≤14 d）行药物机械血栓清除治疗患者的临床资料。根据术中血管造影评价即时血栓清除效果，根据术后第3、6、12个月患者随访时的CEAP分级、多普勒超声检查或血管造影检查评价近期疗效。
结果：38例中37例在使用AngioJet吸栓过程中喷注尿激酶，31例吸栓后一期置入髂静脉支架，11例患者辅助接触性导管溶栓术（CDT）；术后3级血栓清除（完全清除）18例（47.4%），2级血栓清除（50%~99%清除）20例（52.6%），无1级血栓清除病例（<50%清除）。37例患者术后出现不同程度的血红蛋白尿，均在12~24 h内消。随访期间，1例患者（3.3%）进行了再次手术干预，无手术相关的严重并发症和死亡发生。
结论：对于急性左髂股静脉血栓形成的治疗，药物机械血栓清除术的近期疗效显著且安全性好，联合CDT或支架置入术可以提高血栓清除效率。
关键词：
静脉血栓形成；髂静脉；股静脉；血栓切除术
方法：回顾性分析2016年1月—2017年4月期间两个血管外科中心连续收治的38例急性左髂股静脉血栓形成（病程≤14 d）行药物机械血栓清除治疗患者的临床资料。根据术中血管造影评价即时血栓清除效果，根据术后第3、6、12个月患者随访时的CEAP分级、多普勒超声检查或血管造影检查评价近期疗效。
结果：38例中37例在使用AngioJet吸栓过程中喷注尿激酶，31例吸栓后一期置入髂静脉支架，11例患者辅助接触性导管溶栓术（CDT）；术后3级血栓清除（完全清除）18例（47.4%），2级血栓清除（50%~99%清除）20例（52.6%），无1级血栓清除病例（<50%清除）。37例患者术后出现不同程度的血红蛋白尿，均在12~24 h内消。随访期间，1例患者（3.3%）进行了再次手术干预，无手术相关的严重并发症和死亡发生。
结论：对于急性左髂股静脉血栓形成的治疗，药物机械血栓清除术的近期疗效显著且安全性好，联合CDT或支架置入术可以提高血栓清除效率。
Short-term efficacy of combined pharmacological and mechanical thrombectomy in treatment of acute left iliacofemoral vein thrombosis
CorrespondingAuthor:MENG Qingyi Email: 1543864012@qq.com
Abstract
Objective: To evaluate the short-term efficacy of combined pharmacological and mechanical thrombectomy (AngioJetthromectomy system) in treatment of acute left iliacofemoral venous thrombosis.
Methods: The clinical data of 38 consecutive patients with acute left iliacofemoral vein thrombosis (disease onset less than or equal to 14 d) undergoing combined pharmacological and mechanical thrombectomy in two Vascular Surgery Centers from January 2016 to April 2017 were retrospectively analyzed. The immediate effect of thrombus aspiration was evaluated by intraoperative angiography, and the short-term efficacy was assessed by CEAP classification, Doppler ultrasound examination or angiography at 3-, 6- and 12-month follow-up visits.
Results: Of the 38 patients, 37 cases received urokinase spray during AngioJet thrombus aspiration, 31 cases underwent first-stage iliac vein stenting after thrombus aspiration, and 11 cases were treated with adjunctive catheter-directed thrombolysis (CDT). After operation, grade III thrombus clearance (complete clearance) was achieved in 20 patients (47.4%), grade II thrombus clearance (50% to 99% clearance) was obtained in 18 patients (52.6%), and grade I thrombus clearance (<50% clearance) was absent. Varying degrees of hemoglobinuria occurred in 37 patients after operation, which all disappeared within 12 to 24 h. During follow-up, one patient (3.3%) required repeated surgical intervention, and no serious complications related to operation or death occurred.
Conclusion: For acute left iliacofemoral vein thrombosis, the combined pharmacological and mechanical thrombectomy has demonstrable short-term efficacy and favorable safety. Combined CDT or stent placement may increase the efficiency of thrombus clearance.
Keywords：
Venous Thrombosis; Iliac Vein; Femoral Vein; Thrombectomy
Methods: The clinical data of 38 consecutive patients with acute left iliacofemoral vein thrombosis (disease onset less than or equal to 14 d) undergoing combined pharmacological and mechanical thrombectomy in two Vascular Surgery Centers from January 2016 to April 2017 were retrospectively analyzed. The immediate effect of thrombus aspiration was evaluated by intraoperative angiography, and the short-term efficacy was assessed by CEAP classification, Doppler ultrasound examination or angiography at 3-, 6- and 12-month follow-up visits.
Results: Of the 38 patients, 37 cases received urokinase spray during AngioJet thrombus aspiration, 31 cases underwent first-stage iliac vein stenting after thrombus aspiration, and 11 cases were treated with adjunctive catheter-directed thrombolysis (CDT). After operation, grade III thrombus clearance (complete clearance) was achieved in 20 patients (47.4%), grade II thrombus clearance (50% to 99% clearance) was obtained in 18 patients (52.6%), and grade I thrombus clearance (<50% clearance) was absent. Varying degrees of hemoglobinuria occurred in 37 patients after operation, which all disappeared within 12 to 24 h. During follow-up, one patient (3.3%) required repeated surgical intervention, and no serious complications related to operation or death occurred.
Conclusion: For acute left iliacofemoral vein thrombosis, the combined pharmacological and mechanical thrombectomy has demonstrable short-term efficacy and favorable safety. Combined CDT or stent placement may increase the efficiency of thrombus clearance.