导管接触性溶栓联合髂静脉支架治疗下肢深静脉血栓形成的疗效及预后分析

王文斌; 詹焱青; 韩珑; 李阳洋; 李永生

doi:10.16766/j.cnki.issn.1674-4152.002080

导管接触性溶栓联合髂静脉支架治疗下肢深静脉血栓形成的疗效及预后分析

doi: 10.16766/j.cnki.issn.1674-4152.002080

1.
安徽医科大学第四附属医院普外科，安徽合肥 230000
2.
安徽医科大学第一附属医院普外科血管甲状腺病区，安徽合肥 230000

基金项目:

国家自然科学基金项目 81500373

安徽省重点研究与开发计划项目 202004j07020035

安徽省自然科学基金面上项目 1608085MH193

详细信息

通讯作者:
李永生，E-mail：872868848@qq.com

中图分类号: R543.6 R654.3
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出版历程
- 收稿日期: 2020-08-25
- 网络出版日期: 2022-02-15

Efficacy and prognosis of catheter-directed thrombolysis combined with iliac vein stenting for deep vein thrombosis

1.
Department of General Surgery, the Fourth Affiliated Hospital to Anhui Medical University, Hefei, Anhui 230000, China

摘要

摘要: 目的比较导管接触性溶栓联合髂静脉支架植入与外周溶栓治疗下肢深静脉血栓合并髂静脉狭窄的疗效。方法回顾性分析2014年12月—2019年12月于安徽医科大学附属第四医院普外科就诊的下肢深静脉血栓合并髂静脉狭窄患者，42例患者中15例行外周溶栓术(系统溶栓组)，27例行导管接触性溶栓或联合髂静脉支架植入术(导管溶栓组)，比较2组并发症、血栓溶解有效率以及血栓后综合征的发生率。结果系统溶栓组及导管溶栓组的溶栓剂量分别为(335±134)万U和(304±116)万U，系统溶栓组出现并发症4例，导管溶栓组出现并发症2例，2组溶栓剂量、并发症发生率比较差异无统计学意义(均P>0.05)；系统溶栓组和导管溶栓组的溶栓有效率分别为53.33%和88.89%，导管溶栓组的血栓溶解有效率高于系统溶栓组(P < 0.05)，系统溶栓组和导管溶栓组的Villalta评分分别为2.53分和1.77分，导管溶栓组的血栓后综合征发生率低(P < 0.01)；此外，系统溶栓组VEINES-QOL/Sym分别为35.33分及32.67分，而导管溶栓组VEINES-QOL/Sym分别为49.00分及45.67分，显著高于系统溶栓组(P < 0.01)。结论导管接触性溶栓联合髂静脉支架对于下肢深静脉血栓伴有髂静脉狭窄的患者有更好的疗效。
- 下肢深静脉血栓 /
- 髂静脉狭窄 /
- 导管接触性溶栓 /
- 髂静脉支架 /
- 疗效
Abstract: Objective To compare the efficacy between catheter-directed thrombolysis combined with iliac vein stent implantation and peripheral thrombolysis in the treatment of lower extremity deep vein thrombosis with iliac vein stenosis. Methods A retrospective analysis was performed on patients diagnosed with deep vein thrombosis combined with iliac vein stenosis in our institution from December 2014 to December 2019. A total of 42 cases were included in this study, 15 of which underwent peripheral thrombolysis (systematic thrombolysis group) and 27 of which received catheter-directed thrombolysis combined with iliac vein stenting (catheter-directed thrombolysis group). Clinical data including complications, effective rate of thrombolysis and incidence of post-thrombotic syndrome were collected and compared between the two groups. Results The thrombolytic doses of the systemic thrombolysis group and catheter-directed thrombolysis group were (3.35±1.34) and (3.04±1.16) million U, respectively. Three patients in the systematic thrombolysis group and two patients in the catheter-directed thrombolysis group had complications. No significant difference was observed in the thrombolytic dose and complication rate between the two groups (all P>0.05); the effective rate of thrombolysis in the systemic thrombolytic group was 53.33%, whilst the rate was 88.89% in the catheter-directed thrombolysis group, which was higher than that in the systematic thrombolysis group (P < 0.05). The average Villalta score of the systematic thrombolysis group was 2.53 points, and that of the catheter-directed thrombolysis group was 1.77 points. The incidence of post-thrombotic syndrome was lower in the catheter-directed thrombolysis group than in the systematic thrombolysis group (P < 0.01). In addition, the VEINES-QOL/Sym scores in the systematic thrombolysis group were 35.33 and 32.67 points, whilst those in the catheter-directed thrombolysis group were 49.00 and 45.67 points. The scores were significantly higher in the catheter-directed thrombolysis group than in the systematic thrombolysis group (P < 0.01). Conclusion Catheter-directed thrombolysis combined with iliac vein stent has a better curative effect for patients with deep vein thrombosis of lower extremities with iliac vein stenosis.
- Deep vein thrombosis /
- Iliac vein stenosis /
- Catheter-directed thrombolysis /
- Iliac vein stent /
- Curative effect

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图 1 随访期间2组下肢深静脉血栓患者Villalta评分比较

注：^aP < 0.01。

下载: 全尺寸图片幻灯片

图 2 2组下肢深静脉血栓患者VEINES-QOL/Sym分数比较

注：^aP < 0.01。

下载: 全尺寸图片幻灯片

表 1 2组下肢深静脉血栓患者一般情况比较

组别	例数	性别(例)		患肢(例)			年龄(x±s，岁)	发病时间(x±s，d)
组别	例数	男性	女性	左	右	双下肢	年龄(x±s，岁)	发病时间(x±s，d)
系统溶栓组	15	7	8	9	4	2	52.8±12.9	7.4±6.6
导管溶栓组	27	11	16	14	9	4	48.4±14.8	7.6±6.7
统计量		0.138^a		0.270^a			0.970^b	0.124^b
P值		0.710		0.874			0.338	0.902
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组下肢深静脉血栓患者住院期间治疗情况比较

组别	例数	住院时间[M(P₂₅, P₇₅), d]	溶栓天数(x±s，d)	每日溶栓剂量[M(P₂₅, P₇₅), 万U]	总溶栓剂量(x±s, 万U)
系统溶栓组	15	10(6, 14)	7.5±3.4	38(33，59)	335±134
导管溶栓组	27	10(7, 18)	7.0±3.4	38(33，65)	304±116
统计量		1.066^a	0.515^b	0.039^a	0.799^b
P值		0.286	0.609	0.969	0.429
注：^a为U值，^b为t值。

下载: 导出CSV

表 3 2组下肢深静脉血栓患者溶栓效果比较

组别	例数	有效例数	溶栓有效率(%)	并发症(例)
组别	例数	有效例数	溶栓有效率(%)	感染	皮下淤血	脑出血
系统溶栓组	15	8	53.33	2	2	0
导管溶栓组	27	24	88.89	1	0	1
χ²值		4.903			1.560
P值		0.027			0.212

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参考文献(15)

[1]	李晓强, 张福先, 王深明. 深静脉血栓形成的诊断和治疗指南(第三版)[J]. 中国血管外科杂志(电子版), 2017, 9(4): 250-257. doi: 10.3969/j.issn.1674-7429.2017.04.003
[2]	陈世远, 高涌, 聂中林, 等. 介入联合手术治疗下肢深静脉血栓形成[J]. 中华全科医学, 2010, 8(3): 288-289. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201003011.htm
[3]	MING Z B, LI W D, YUAN R F, et al. Effectiveness of catheter directed thrombolysis and stent implantation on iliofemoral vein thrombosis caused by iliac vein compression[J]. J Thromb Thrombolysis, 2017, 44(2): 254-260. doi: 10.1007/s11239-017-1515-z
[4]	ALESH I, KAYALI F, STEIN P D. Catheter-directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: A systematic review[J]. Catheter Cardiovasc Interv, 2007, 70(1): 143-148. http://www.onacademic.com/detail/journal_1000033793184710_68eb.html
[5]	DU X L, KONG L S, MENG Q Y, et al. Safety and efficacy of low dosage of urokinase for catheter-directed thrombolysis of deep venous thrombosis[J]. Chin Med J (Engl), 2015, 128(13): 1787-1792. doi: 10.4103/0366-6999.159355
[6]	赵国瑞, 任建庄, 段旭华, 等. 腔内介入治疗Cockett综合征伴左下肢深静脉血栓形成[J]. 介入放射学杂志, 2017, 26(6): 522-526. doi: 10.3969/j.issn.1008-794X.2017.06.011
[7]	王孝运, 段鹏飞, 倪才方. 下肢深静脉血栓形成伴髂静脉狭窄支架植入与否近中期临床疗效比较[J]. 介入放射学杂志, 2018, 27(12): 1140-1143. doi: 10.3969/j.issn.1008-794X.2018.12.005
[8]	杨继武, 王辉, 廖向群. 急性下肢深静脉血栓导管溶栓后髂静脉狭窄的支架治疗[J]. 中华普通外科杂志, 2016, 31(1): 62-63.
[9]	SANG H, LI X, QIAN A, et al. Outcome of endovascular treatment in postthrombotic syndrome[J]. Ann Vasc Surg, 2014, 28(6): 1493-1500. doi: 10.1016/j.avsg.2014.03.031
[10]	ENDEN T, HAIG Y, KLØW N E, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): A randomised controlled trial[J]. Lancet, 2012, 379(9810): 31-38. doi: 10.1016/S0140-6736(11)61753-4
[11]	GOPAL M, HWANG S, VOUYOUKA A, et al. Lessons learned from reinterventions after vein stent placements[J]. J Vasc Surg, 2020, 72(1): e171.
[12]	BOZKAYA H, CINAR C, ERTUGAY S, et al. Endovascular treatment of iliac vein compression (May-Thurner) syndrome: Angioplasty and stenting with or without manual aspiration thrombectomy and catheter-directed thrombolysis[J]. Ann Vasc Dis, 2015, 8(1): 21-28. doi: 10.3400/avd.oa.14-00110
[13]	MURPHY E H, JOHNS B, VARNEY E, et al. Deep venous thrombosis associated with caval extension of iliac stents[J]. J Vasc Surg Venous Lymphat Disord, 2017, 5(1): 8-17. doi: 10.1016/j.jvsv.2016.09.002
[14]	张袁骕, 梅统, 陈金晖, 等. 深静脉血栓患者经机械吸栓治疗后的生活质量分析[J]. 中国基层医药, 2020, 27(12): 1495-1498. doi: 10.3760/cma.j.issn.1008-6706.2020.12.020
[15]	刘澄, 李晓强. 髂静脉闭塞支架治疗的现状[J]. 中国血管外科杂志(电子版), 2019, 11(3): 165-167. https://www.cnki.com.cn/Article/CJFDTOTAL-XGWK201903002.htm