CAJ | 학술논문

目的评估手术取栓加药物溶栓与单纯药物溶栓治疗急性髂股型下肢深静脉血栓形成的疗效.方法回顾性分析175例髂股型下肢深静脉血栓形成患者的临床资料,依据治疗方式的不同分为取栓组与溶栓组;手术取栓组85例,其中合并髂总静脉狭窄或闭塞的46例,选择于术或介入治疗,术后给予尿激酶、低分子肝素治疗.采取药物溶栓抗凝治疗90例,仪给予尿激酶、低分子肝素治疗.治疗前两组患者年龄、病程、肿胀程度及伴随疾病比较,差异无统计学意义(P＜0.05).结果治疗后1个月,手术取栓组治愈率71.8%(61/85),双下肢周径差手术组由(4.6±1.6)cm下降为(0.8±0.5)cm;溶栓组治愈率38.9%(35/90);双下肢周径差由(4.0±1.9)cm下降为(1.8±1.3)cm.平均随访(28±11)个月,随访率64.6%,治疗后12个月,双下肢周径差手术组下降为(0.4±0.3)cm,溶栓组下降为(0.9±0.7)cm,手术组治愈率86.0%(49/57),溶栓组治愈率53.6%(30/56);手术组的下肢深静脉血栓形成后遗症发生率低于溶栓组(P＜0.05),手术组的静脉瓣功能异常的发生率低于溶栓组(P＜0.05).结论急性髂股型下肢深静脉血栓形成手术取栓加溶栓疗效优于单纯药物溶栓.
목적 평고수술취전가약물용전여단순약물용전치료급성가고형하지심정맥혈전형성적료효.방법 회고성분석175례가고형하지심정맥혈전형성환자적림상자료,의거치료방식적불동분위취전조여용전조;수술취전조85례,기중합병가총정맥협착혹폐새적46례,선택우술혹개입치료,술후급여뇨격매、저분자간소치료.채취약물용전항응치료90례,의급여뇨격매、저분자간소치료.치료전량조환자년령、병정、종창정도급반수질병비교,차이무통계학의의(P＜0.05).결과 치료후1개월,수술취전조치유솔71.8%(61/85),쌍하지주경차수술조유(4.6±1.6)cm하강위(0.8±0.5)cm;용전조치유솔38.9%(35/90);쌍하지주경차유(4.0±1.9)cm하강위(1.8±1.3)cm.평균수방(28±11)개월,수방솔64.6%,치료후12개월,쌍하지주경차수술조하강위(0.4±0.3)cm,용전조하강위(0.9±0.7)cm,수술조치유솔86.0%(49/57),용전조치유솔53.6%(30/56);수술조적하지심정맥혈전형성후유증발생솔저우용전조(P＜0.05),수술조적정맥판공능이상적발생솔저우용전조(P＜0.05).결론 급성가고형하지심정맥혈전형성수술취전가용전료효우우단순약물용전.
Objective To evaluate efficacy on treatment of acute iliofemoral lower extremity deep venous thrombosis with thrombectomy and pharmacological thrombolysis or pharmacological thrombolysis alone. Methods The clinical data of 175 cases of lower extremity iliofemoral deep venous thrombosis wereanalysed retrospectively. Patients were divided into thrombectomy group and thrombolysis group. There were 85 patients treated by thrombectomy, among these patients there were 46 with common iliac vein occlusion or stenosis. According to state of illness suitable treatment was selected, urokinase and low molecular weight heparin were given after operation. The other 90 patients were treated by pharmacological thrombolysis only,including urokinase and low molecular weight heparin. Results No significant differences were found in age, course of disease, swelling and associated diseases between the two groups before treatment (P ＜0. 05); After 1 month of treatment the circumference difference between bilateral limbs was reduced from (4.6±1.6) cm to (0.8 ±0.5) cm in operation group,and declined from (4.0±1.9) cm to (1.8 ±1.3) cm in thrombolysis group. The cure rate was 71.8% (61/85) in thrombectomy group and 38.9% (35/90) in thrombolysis group. 64.6% patients were followed up for an average of (28 ± 11 ) months.After 12 months of treatment the circumference difference between bilateral limbs was (0.4 ± 0.3 ) cm in thrombectomy group and ( 0.9 ± 0.7 ) cm in thrombolysis group respectively. The cure rate was 86.0% (49/57) in thrombectomy group and 53.6% (30/56) in thrombolysis group. In surgical group the incidence of deep venous thrombosis sequelae was less than in thrombolysis group( P ＜0. 05 ). The incidence of venous valve dysfunction in thrombectomy group was less than in thrombolysis group (P ＜ 0.05 ).Conclusions Thrombectomy and pharmacological thrombolysis was more effective than pharmacological thrombolysis alone in the treatment of acute iliofemoral deep venous thrombosis.