CAJ | 학술논문

目的根据急性下肢深静脉血栓形成( DVT)的部位,比较单纯抗凝、足背静脉顺行溶栓及介入治疗3种方法的疗效.方法回顾性分析204例急性下肢DVT患者的临床资料、静脉造影结果及治疗方法.根据血栓解剖部位将DVT分为3型:周围型、中央型和混合型.每型DVT根据治疗方法分为3组.A组(37例)单纯抗凝,B组(55例)足背静脉顺行溶栓,C组(112例)介入治疗.评价每型DVT患者住院期间选择不同治疗方法的效果.根据临床症状及造影复查计算各种治疗方法的优良率,其比较采用x2检验.结果急性DVT发生于左下肢、右下肢、双下肢分别有132、62和10例,分别有4例(3.0％)、5例(8.1％)和2例合并肺栓塞(PE),左、右、双下肢DVT合并PE的比率差异有统计学意义(x2=6.494,P=0.039).周围型、中央型、混合型DVT分别有23、48和133例,分别有2(8.7％)、5(10.4％)和4例(3.0％)合并PE,三者发生PE的比率差异无统计学意义(x2=4.350,P=0.114).23例周围型DVT中,A、B组分别为5和18例,治疗达到优良者分别为2和11例；48例中央型DVT中,A、B、C组分别为10、5和33例,治疗后达到优良的分别为1、2和26例,差异有统计学意义(x2= 16.157,P=0.000)；133例混合型DVT中,A、B、C组分别为22、32和79例,治疗后达到优良的分别为1、10和65例,差异有统计学意义(x2= 53.993,P=0.000).结论急性下肢DVT在左下肢患病率较右下肢高,且以混合型为主.3种方法中,中央型和混合型DVT介入治疗疗效最好,可根据血栓解剖分布类型指导治疗方案的选择.
목적 근거급성하지심정맥혈전형성( DVT)적부위,비교단순항응、족배정맥순행용전급개입치료3충방법적료효.방법 회고성분석204례급성하지DVT환자적림상자료、정맥조영결과급치료방법.근거혈전해부부위장DVT분위3형:주위형、중앙형화혼합형.매형DVT근거치료방법분위3조.A조(37례)단순항응,B조(55례)족배정맥순행용전,C조(112례)개입치료.평개매형DVT환자주원기간선택불동치료방법적효과.근거림상증상급조영복사계산각충치료방법적우량솔,기비교채용x2검험.결과 급성DVT발생우좌하지、우하지、쌍하지분별유132、62화10례,분별유4례(3.0％)、5례(8.1％)화2례합병폐전새(PE),좌、우、쌍하지DVT합병PE적비솔차이유통계학의의(x2=6.494,P=0.039).주위형、중앙형、혼합형DVT분별유23、48화133례,분별유2(8.7％)、5(10.4％)화4례(3.0％)합병PE,삼자발생PE적비솔차이무통계학의의(x2=4.350,P=0.114).23례주위형DVT중,A、B조분별위5화18례,치료체도우량자분별위2화11례；48례중앙형DVT중,A、B、C조분별위10、5화33례,치료후체도우량적분별위1、2화26례,차이유통계학의의(x2= 16.157,P=0.000)；133례혼합형DVT중,A、B、C조분별위22、32화79례,치료후체도우량적분별위1、10화65례,차이유통계학의의(x2= 53.993,P=0.000).결론 급성하지DVT재좌하지환병솔교우하지고,차이혼합형위주.3충방법중,중앙형화혼합형DVT개입치료료효최호,가근거혈전해부분포류형지도치료방안적선택.
Objective To investigate the anatomical distribution of acute deep venous thrombosis (DVT) of the lower extremity,and compare different therapeutic methods including anticoagulation alone,thrombolysis through dorsal vein and interventional therapy.Methods The clinical data,venography and therapies of 204 acute DVT patients were retrospectively studied According to the distribution,DVT were classified into three types including peripheral,central and mixed types.According to the difference of the therapeutic method,each type of DVT was divided into three groups,Group A (37 patients) anticoagulation alone:Group B(55 patients) thrombolysis through dorsal vein:and Group C( 112 patients) interventional therapy.The results of different kind of treatment method in each type of DVT were evaluated before the patients were discharged and the Chi-square test was used for statistical analysis.Results There were 132 patients with DVT in the left lower extremity,62 in right lower extremity,and 10 in both extremities.The complication of pulmonary embolism (PE) occurred in 4,5 and 2 cases respectively,and the morbidity was 3.0％,8.1％ and 20.0％ ( x2 = 6.494,P = 0.039 ) respectively.There was significant statistical difference among them.There were 23 cases of peripheral type of DVT,48 central type and 133 mixed type.The complication of PE were observed in 2,5 and 4 cases respectively in each type.The morbidity was 8.7％,10.4％ and 3.0％ respectively ( x2 = 4.350,P = 0.114 ).There were no statistical significance among them.In the 23 cases of peripheral type DVTs,2 of 5 in group A and 11 of 18 in group B had excellent therapeutic response.In the 48 cases of central type of DVTs,1 of 10 in group A,2 of 5 in in group B and 26 of 33 in group C had excellent therapeutic response.There were statistically significant differences among groups A,B and C ( x2 = 16.157,P =0.000).In the 133 cases of mixed type DVTs,1 of 22 in group A,10 of 32 in group B and 65 of 79 in group C had excellent therapeutic response.There were statistically significant differences among group A,B and C ( 1,10,65 cases,x2 = 53.993,P =0.000).Conclusions The incidence of acute DVT involving the left lower extremity was higher than that involving the right one,and the majority of cases was of the mixed type.The treatment of choice for the central and mixed types was interventional therapy.Analysis of anatomical distribution of deep venous thrombosis can guide treatment planning.