CAJ | 학술논문

目的分析比较机械性抽吸与溶栓抗凝治疗急性混合型下肢深静脉血栓形成的疗效.方法回顾性分析380例急性混合型下肢深静脉血栓患者的临床资料,根据治疗方法分为两组.A组(229例):采用局麻下经皮穿刺患侧股静脉,导丝引导下插入12～ 14 F鞘管直接抽吸髋上髂、股静脉内血栓,髋下股、腘静脉血栓,利用Fogarty取栓球囊导管将血栓拖拉至髂、股内,再经患侧股静脉机械性抽吸血栓；髂、股、腘静脉血栓清除后,113例造影显示髂静脉存在狭窄或闭塞,行经皮血管腔内成行术或支架置入辅助处理；腘静脉以下残存血栓,术后辅以小剂量尿激酶溶栓和肝素抗凝.B组(151例):采用单纯尿激酶溶栓、肝素抗凝.结果患肢肿胀、疼痛开始消退或减轻；A组术后当日,而B组则于术后3-7d.血栓完全清除(Ⅰ级):A组(63.32％)明显高于B组(37.09％)(x2=20.53,P=0.002).结论急性混合型下肢深静脉血栓机械性血栓抽吸优于单纯抗凝溶栓治疗,尤其在保护静脉瓣膜功能方面更具优势；血栓抽吸配合髂静脉成形是治疗髂静脉受压综合征合并急性深静脉血栓形成更为有效的治疗方法.
목적 분석비교궤계성추흡여용전항응치료급성혼합형하지심정맥혈전형성적료효.방법 회고성분석380례급성혼합형하지심정맥혈전환자적림상자료,근거치료방법분위량조.A조(229례):채용국마하경피천자환측고정맥,도사인도하삽입12～ 14 F초관직접추흡관상가、고정맥내혈전,관하고、객정맥혈전,이용Fogarty취전구낭도관장혈전타랍지가、고내,재경환측고정맥궤계성추흡혈전；가、고、객정맥혈전청제후,113례조영현시가정맥존재협착혹폐새,행경피혈관강내성행술혹지가치입보조처리；객정맥이하잔존혈전,술후보이소제량뇨격매용전화간소항응.B조(151례):채용단순뇨격매용전、간소항응.결과 환지종창、동통개시소퇴혹감경；A조술후당일,이B조칙우술후3-7d.혈전완전청제(Ⅰ급):A조(63.32％)명현고우B조(37.09％)(x2=20.53,P=0.002).결론 급성혼합형하지심정맥혈전궤계성혈전추흡우우단순항응용전치료,우기재보호정맥판막공능방면경구우세；혈전추흡배합가정맥성형시치료가정맥수압종합정합병급성심정맥혈전형성경위유효적치료방법.
Objective To compare the clinical effect of manual aspiration thrombectomy versus systemic thrombolysis for acute lower extremity deep venous thrombosis of mixed type.Methods The clinical data of 380 patients with acute lower extremity deep venous thrombosis of nixed type was analyzed retrospectively,who were classified into two groups according to treatment methods.Group A (229 cases):the ipsilateral femoral vein was accessed under local anesthesia,a 12-14 F sheath was introduced via a guide wire to aspirate iliofenoral thrombus.As for the femoropopliteal thrombus,a Fogarty balloon catheter was introduced to pull thrombus to iliac vein,then mechanical aspiration thrombectomy was performed.One hundred and thirteen patients with stenosis or occlusion of comnon iliac vein were treated with adjunctive PTA and stenting.As for the residual thrombus bclow popliteal vein,a small dose urokinase vas given to thrombolysis and heparin anticoagulation after procedure.Group B(151 cases) were treated by systemic thrombolysis and anticoagulation with heparin.Results The swelling and pain of affected limbs of group A began to relief after operation immediately,but these times of group B was 3-7 days after operation.The thrombus was eliminated completely(Grade Ⅰ):goup A was better than group B (63.32％ vs 37.09％) (x2 =20.53,P =0.002).Conclusions The manual aspiration thrombectomy was superior to simple systemic thrombolysis in treating acute lower extremity deep venous thrombosis of mixed type,especially in protecting the normal valve function that was better than thrombolysis,aspiration thrombectomy with adjunctive iliac vein angioplasty was a more reasonable method to treat acute LEDVT.