CAJ | 학술논문

目的：观察老年急性下肢深静脉血栓形成患者手术取栓和溶栓治疗的疗效，探讨其最佳治疗方法。方法老年急性下肢深静脉血栓形成患者245例，11例采用单纯手术取栓，84例采用杂交手术治疗，121例采用全身系统性药物溶栓，29例采用联合腔静脉滤器导管直接溶栓。结果186例患者获得随访，随访率75.9％，随访时间4~86个月，平均49个月。症状完全消失者中，单纯手术取栓组占27.2％（3/11），杂交手术治疗组占21.4％（15/70），导管直接溶栓组占50％（8/16），均高于全身系统性药物溶栓组13.1％（12/92）。全身系统性药物溶栓组肢体发生浅静脉曲张和皮肤色素沉着者占48.9％，均高于其他三组。结论手术取栓可以保护部分患者下肢的主干深静脉瓣膜，减少下肢深静脉血栓后综合征的发生率；联合腔静脉滤器导管直接溶栓是一种安全、有效的治疗方法，是治疗老年人下肢下肢深静脉血栓形成的首选方法。
목적：관찰노년급성하지심정맥혈전형성환자수술취전화용전치료적료효，탐토기최가치료방법。방법노년급성하지심정맥혈전형성환자245례，11례채용단순수술취전，84례채용잡교수술치료，121례채용전신계통성약물용전，29례채용연합강정맥려기도관직접용전。결과186례환자획득수방，수방솔75.9％，수방시간4~86개월，평균49개월。증상완전소실자중，단순수술취전조점27.2％（3/11），잡교수술치료조점21.4％（15/70），도관직접용전조점50％（8/16），균고우전신계통성약물용전조13.1％（12/92）。전신계통성약물용전조지체발생천정맥곡장화피부색소침착자점48.9％，균고우기타삼조。결론수술취전가이보호부분환자하지적주간심정맥판막，감소하지심정맥혈전후종합정적발생솔；연합강정맥려기도관직접용전시일충안전、유효적치료방법，시치료노년인하지하지심정맥혈전형성적수선방법。
Objective To observe the efficacy of embolectomy and thrombolysis for acute deep vein thrombosis of the lower extremity and to explore the optimal method. Methods A total of 245 aged patients with acute deep vein thrombosis of the lower extremity were enrolled. Eleven patients were treated by simple embolectomy,84 patients were treated by hybrid operation,121 patients were treated by thrombo-lytic agents and 29 patients were treated by catheter direct thrombolysis and vena cava filter. Results A total of 186 patients(75. 92%)were followed up. The follow-up time ranged from 4 months to 86 months, with an average of 49 months. The percentages of patients without symptoms were 27. 2%(3/11)in the simple embolectomy group,21. 4%(15/70)in the hybrid operation group,and 50%(8/16)in the catheter direct thrombolysis group,which were higher than the 13. 1%(12/92)in the thrombolytic agent group. In the thrombolytic agent group,patients with superficial varicosity and dermal pigmentation in the lower ex-tremity accounted for 48. 9%,which was higher than the other groups. Conclusion Embolectomy can pro-tect the valve of deep venous trunk in some patients and reduce the incidence of post-thrombotic syn-drome. Combined with vena cava filter,catheter direct thrombolysis is a safe and effective method,which is the priority for aged patients with acute deep vein thrombosis of the lower extremity.