经皮穿刺胫后静脉入路治疗急性混合型单侧下肢深静脉血栓形成的疗效

张明照; 卢冉; 向军益; 李博; 秦荣清; 张宇博; 周兵

doi:10.16766/j.cnki.issn.1674-4152.002400

经皮穿刺胫后静脉入路治疗急性混合型单侧下肢深静脉血栓形成的疗效

doi: 10.16766/j.cnki.issn.1674-4152.002400

1.
杭州师范大学附属医院介入血管科，浙江杭州 310015
2.
蚌埠医学院第一附属医院血管外科，安徽蚌埠 233004
3.
浙江中医药大学第二附属医院介入治疗科，浙江杭州 310005

基金项目:

安徽高校自然科学研究项目 KJ2019A0327

浙江省医药卫生科技计划项目 2020KY674

详细信息

通讯作者:
周兵，E-mail：zbing8888@163.com

中图分类号: R654.4 R364.15
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出版历程
- 收稿日期: 2021-04-18
- 网络出版日期: 2022-08-20

Exploring the efficacy of percutaneous puncture of the posterior tibial vein access in the treatment of acute mixed unilateral lower extremity deep vein thrombosis

1.
Department of Interventional Vascular Surgery, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的探讨在全程透视下经皮穿刺患侧小腿段胫后静脉, 并经此入路行导管接触性溶栓治疗急性混合型单侧下肢深静脉血栓形成(DVT)的疗效。方法回顾性分析杭州师范大学附属医院2017年1月-2020年12月收治的60例急性混合型单侧下肢DVT患者的临床资料, 均行透视下经皮穿刺患侧小腿段胫后静脉入路留置导管溶栓治疗。对比治疗前后健、侧大腿的周径差以及小腿的周径差、肢体消肿率、静脉通畅评分、置管消耗时间、并发症及血栓后综合症(PTS)的发生情况, 评价治疗效果。结果治疗后健、患侧大腿的周径差为(0.98±0.86)cm、小腿的周径差为(0.85±0.57)cm, 优于治疗前的(4.56±1.37)cm、(3.51±0.98)cm(均P < 0.01)。大腿消肿率为(78.53±17.72)%、小腿消肿率为(75.79±17.08)%。溶栓后静脉通畅评分[1.0(0.0, 2.0)分]优于溶栓前[5.0(5.0, 6.0)分, P < 0.01]。置管消耗时间为(37.02±9.72)min。2例为腹股沟穿刺点附近皮下广泛淤血, 1例为小腿置鞘部位渗血。未发生重要脏器出血等严重并发症。患者均得到随访, 随访时间为10~14个月, 7例有活动后轻度肿胀, 1例在术后约10个月复发。结论透视下经皮穿刺患侧小腿段胫后静脉入路导管溶栓治疗急性混合型单侧下肢DVT, 具有疗效确切、操作简单、并发症少、患者舒适度高, 护理方便, PTS发生率低等优点, 值得临床上推广应用。
- 急性下肢深静脉血栓形成 /
- 胫后静脉 /
- 导管溶栓
Abstract: Objective To investigate the efficacy of percutaneous puncture of the posterior tibial vein of the affected calf segment under full fluoroscopy and catheter-contact thrombolysis via this approach in the treatment of acute mixed unilateral lower extremity deep vein thrombosis (DVT). Methods The clinical data of 60 patients with acute mixed unilateral lower extremity DVT admitted to Hangzhou Normal University Hospital from January 2017 to December 2020 were retrospectively analyzed, and all of them were treated with fluoroscopic percutaneous puncture of the posterior tibial vein access to the affected calf segment with indwelling catheters for thrombolysis. The circumference difference between the healthy and affected thighs and the circumference difference between the calves, limb swelling reduction rate, the venous patency score, the time consumed for catheter placement, the occurrence of complications and post-thrombotic syndrome (PTS) were compared to evaluate the treatment effect. Results The difference in circumference between the healthy and affected thighs after treatment was [(0.98±0.86) cm and (0.82±0.57) cm], which was better than that before treatment [(4.56±1.37) cm and (3.51±0.98) cm, all P < 0.01]. The rate of swelling reduction was (78.53±17.72) % in the thigh and (75.79±17.08) % in the calf. The post-thrombolytic venous patency score [1.0(0.0, 2.0) points] was better than the pre-thrombolytic score [5.0(5.0, 6.0) points, P < 0.01]. The mean time of cannulation consumption was (37.02±9.72) minutes. Two cases had extensive subcutaneous ecchymosis near the inguinal puncture site and 1 case had blood leakage from the calf sheath placement site. No serious complications such as bleeding from vital organs occurred. Patients were followed up for a mean of 10-14 months. Seven cases had mild swelling after activity, and 1 case recurred about 10 months after the procedure. Conclusion Thrombolysis by percutaneous puncture of the posterior tibial vein access catheter in the affected calf segment under fluoroscopy for acute mixed unilateral lower extremity DVT has the advantages of precise efficacy, simple operation, few complications, high patient comfort, convenient care, and low incidence of PTS, and is worthy of clinical application.
- Acute lower extremity deep vein thrombosis /
- Posterior tibial vein /
- Catheter thrombolysis

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