临床研究(Clinical Research)

DSA引导下胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成

Published at: 2017年第26卷第6期

刘飒华 1 , 肖占祥 1 , 戚悠飞 1 , 岳劼 1 , 陈浩 1 , 曾昭凡 1 , 李振振 1
1 海南省人民医院 血管外科,海南 海口 570311
通讯作者 占祥 肖 Email: xiaozhanxianghn@sina.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.06.014
基金:

摘要

目的:初步探讨DSA引导下行胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成(DVT)的疗效。方法:对2012年8月—2016年11月收治的87例混合型及中央型DVT患者行DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗,以术前、术后肢体的周径差以及溶栓后造影深静脉通畅情况评估疗效。结果: 87例患者80例穿刺成功(91.9%),其中胫后静脉穿刺成功68例,胫前静脉穿刺成功12例,未穿刺成功7例行胫后静脉切开置管。置管成功后均行碎栓术,并行留置导管溶栓。与溶栓前比较,溶栓后患者小腿周径差明显减小[(4.28±1.02) cm vs. (1.06±0.42 cm)],静脉通畅度评分明显降低[(10.25±1.84) vs. 1.92±0.5)],差异均有统计学意义(均P<0.05)。结论:DSA引导下经胫后/胫前静脉穿刺置管碎栓/溶栓治疗下肢DVT是一种简便、有效、疗效确切的方法。


DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis

Abstract

Objective: To investigate the efficacy of DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis (DVT). Methods: From August 2012 to November 2016, 87 patients with mixed type and central type acute lower extremity DVT underwent DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis. Effectiveness evaluation was performed by comparison of the limb circumference differences before and after thrombolysis and observation of the angiographic evidence of deep venous patency after thrombolysis. Results: Of the 87 patients, successful puncture was performed in 80 cases (91.9%), of whom 68 cases underwent posterior tibial vein puncture and 12 cases underwent anterior tibial vein puncture; 7 cases with failed puncture underwent catheterization by posterior tibial vein incision. Clot fragmentation combined with catheter-directed thrombolysis was performed in all patients after successful catheterization. Compared with findings before thrombolysis, the limb circumference difference was significantly reduced [(4.28±1.02) cm vs. (1.06±0.42) cm] and venous patency score was significantly decreased [(10.25±1.84) vs. (1.92±0.5)], and all differences had statistical significance (all P<0.05). Conclusion: DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis is a simple and effective method for treatment of acute lower extremity DVT.


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引用本文: 飒华 刘, 占祥 肖, 悠飞 戚, 劼 岳, 浩 陈, 昭凡 曾, 振振 李. DSA引导下胫后/胫前静脉穿刺置管碎栓/溶栓治疗急性下肢深静脉血栓形成 [J]. 中国普通外科杂志, 2017, 26(6): 758-763.
Cite this article as: LIU Sahua, XIAO Zhanxiang, QI Youfei, YUE Jie, CHEN Hao, ZENG Zhaofan, LI Zhenzhen . DSA-guided posterior/anterior tibial vein puncture and catheter-directed clot fragmentation/thrombolysis for acute lower extremity deep venous thrombosis [J]. Chin J Gen Surg, 2017, 26(6): 758-763.