摘要
目的探讨低剂量尿激酶较长时间经导管直接溶栓术（CDT）治疗急性髂．股静脉血栓形成的安全性及临床疗效。方法搜集2005年1月至2011年3月间，采用CDT治疗且至少有12个月临床随访资料的，单侧急性髂-股静脉血栓形成的63例患者的临床资料。对CDT期间患者出现的并发症、血栓清除率、置管灌注持续溶栓时间、尿激酶用量、患肢消肿程度以及临床随访资料进行回顾性分析。计数资料用Fisher精确概率法检验。计量资料多组间比较采用方差分析，两两比较用LSD检验。对不同时间点的血栓清除率比较用重复测量资料的方差分析。结果CDT期间没有肺栓塞和大出血发生，小的出血并发症10例（15．9％），其中沿血管鞘边缘渗血3例、穿刺点周围皮下瘀斑或血肿3例、血尿3例、牙龈出血1例。因置管引起并发症4例（6．3％），其中穿刺点周围软组织炎症表现3例、血管鞘周围继发血栓1例。53例（84．1％）患者CDT第4—8天血栓溶解程度达到Ⅲ级和Ⅱ级。CDT中，尿激酶50万U／d和75U／d灌注溶栓获得的血栓清除率分别为（91．2±10．1）％和（91．3±12．2）％，明显优于25万U／d的（75．9±20．1）％（P〈0．05），但尿激酶50万U／d和75万U／d二者问的血栓清除率差异无统计学意义（P〉0．05）；尿激酶50万U／d和75万U／d灌注溶栓达到Ⅲ级时的平均置管时间[分别为（7．1±0．9）d和（6．2±1．3）d]与Ⅱ级时的平均置管时间[分别为（6．4±1．0）d和（6．0±0．8）d]，差异均无统计学意义（P〉0．05）。随置管灌注时间的延长，平均血栓清除率有增加的趋势（P〈0．05）。CDT24h后58例（92．1％）患肢软组织张力减轻，48h后患肢周径[大腿中部为（54．25±5．79）cm，小腿中部为（44．05±5．18）cm]缩小，同术前[大腿中部为（56．46±5．91）cm，小腿中部为（45．68±5．16）cm]比较差异有统计学意义（P〈0．05），出院时患肢周径[大腿中部为（49．00±4．67）cm，小腿中部为（38．41±4．15）cm]同健侧[大腿中部为（48．38±4．68）cm，小腿中部为（37．73±3．92）cm]比较差异无统计学意义（P〉0．05）。术后6个月时髂静脉支架通畅率91．1％（41／45）。12个月时多普勒超声显示11例开通的股静脉瓣膜功能有反流征象。结论采用低剂量尿激酶、较长时间经导管直接溶栓术治疗急性髂一股静脉血栓形成具有较高的安全性和满意的临床治疗效果。
Objective To investigate the safety and clinical efficacy of catheter-directed thrombolysis （CDT） with prolonged infusion of low dose urokinasefor treatment of acute iliac-femoral vein thrombosis. Methods From January 2005 to March 2011,63 patients of unilateral acute iliac-femoral veinthrombosis were treated by CDT and followed up for more than 12 months. The complications during CDT, thrombus clearance ratio, time for CDT, dose of urokinase, degree of limb swelling and clinical follow-up data were retrospectively reviewed. The Fisher exact test was used for enumeration of data. The measurements of data were tested with the one-way analysis of variance and two-two comparison LSD test. Thrombus clearance ratio in different time frame was tested by repeated measurement of data and analysis of variance. Results During the CDT, no symptomatic pulmonary embolism （PE） and significant bleeding happened. Ten （15.9%） patients had complications of minor bleeding, including 3 patients with blood oozing along the edge of vascular sheath, 3 patients with subcutaneous ecchymosis or hematoma around the puncture site, 3 patients with hematuria and 1 patient with gums bleeding. In four （6.3%） patients, complications were caused by catheter placement, including 3 patients with soft tissue inflammation around puncture site and 1 patient with secondary thrombosis surrounding the vascular sheath. Fifty three patients （84. 1% ） achieved thrombolytic degree Ⅲ and Ⅱ at 4^th to 8^th day during CDT. Thrombus clearance ratio was higher in CDT with urokinase 500 000 U/d and 750 000 U/d than 250 000 U/d[ （91.2 ± 10. 1 ） % vs （75.9±20.1）%, （91.3 ± 12.2）% vs （75.9±20.1）%, all P〈0.05]. Thrombus clearance ratio showed no significant difference between CDT with urokinase 500 000 U/d and 750 000 U/d [ （ 91.2 ± 10. 1 ）% vs （91.3 ± 12. 2）% , P 〉 0. 05 ]. There was no significant difference between C DT with urokinase 500 000 U/d and 750 000 U/d in perfusion thrombolytic time to reach thrombolytic degree Ⅲ [ （7. 1 ± 1.0） vs （6. 2 ± 1.3 ） d, P 〉 0. 051 and Ⅱ [ （6.4 ± 1.0） vs （6. 0 ± 0. 8） d, P 〉 0. 05 ]. Thrombus clearance ratio increased along with an increase in thrombolytic time for CDT （ P 〈 0. 05 ）. After 24 hours of CDT , 58 （92. 1% ） patients showed reduction of soft tissues tension. After 48 hours of CDT, affected limb circumference decreased significantly compared with the preoperative measurement [ thigh （54. 25 ± 5.79） cm vs （56.46±5.91） cm; leg（ 44. 05±5.18） cmvs （45.68±5.16） cm, allP〈0.05]. At the time of discharge, there was no significant difference between affected limb circumference and normal side [thigh （49.00±4.67） cmvs （48.38 ±4.68） cm; leg（38.41 ±4. 15） cm vs （37.73 ±3.92 ）era, all P 〈 0. 051- The patency rate of iliae venous stent was 91.1% （41/45） after 6 months. Doppler ultrasound showed regurgitation of femoral venous valve in 11 patients after 12 months. Conclusions CDT with prolonged infusion of low dose urokinase is a safe, highly effective method for the treatment of acute iliae- femoral venous thrombosis.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2012年第12期1119-1125,共7页
Chinese Journal of Radiology
基金
南京市医学科技发展重点项目（ZKX10004）
“十二五”南京市医学科技发展重大项目（宁卫规财[2012]6号）
关键词
深静脉血栓形成
下肢
髂静脉
股静脉
导管直接溶栓术
安全性
治疗效果
Deep venous thrombosis, lower extremity
Iliac vein
Femoral vein
Catheter-direeted thrombolysis
Safety
Treatment outcome
