中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
31期
2454-2458
,共5页
张希全%于伟娜%王义平%潘晶晶%朱亮%朱伟%张清
張希全%于偉娜%王義平%潘晶晶%硃亮%硃偉%張清
장희전%우위나%왕의평%반정정%주량%주위%장청
深静脉血栓形成,下肢%血栓溶解疗法%取栓,介入性
深靜脈血栓形成,下肢%血栓溶解療法%取栓,介入性
심정맥혈전형성,하지%혈전용해요법%취전,개입성
Deep venous thrombosis,lower extremity%Thrombolysis therapy%Thrombectomy,interventional
目的 比较介入治疗与单纯溶栓对急性混合型下肢深静脉血栓形成(LEDVT)的疗效.方法 回顾分析解放军第一四八中心医院介入血管科1998年4月至2009年12月收治并采用介入取栓与单纯溶栓、病程7d内的急性混合型LEDVT患者458例.A组(327例)机械性血栓抽吸,B组(131例)单纯尿激酶溶栓、肝素抗凝.结果 血栓完全清除(Ⅰ级):A组65.44％明显高于B组37.4％ (P ＜0.01)；出院时健患肢膝上、下15 cm处周径差:A组(1.34±0.57)、(0.93 ±0.32)cm好于B组(1.72-0.69)、(1.29-.0.43) cm(均P＜0.01).411例随访16 ～ 70个月,中位随访时间35个月,随访率89.83％.术后36个月患肢膝下15 cm处周径差,A组(0.53 ±0.22) cm好于B组(1.42±0.65) cm(P ＜0.01)；水肿、色素沉着、溃疡等后遗症发生率,A组29.64％、14.01％、0％；低于B组55.77％、83.65％、9.62％(均P＜0.01)；彩超复查静脉通畅率和瓣膜功能正常率,A组90.23％、71.34％,均高于B组37.50％、15.38％(均P＜0.01)；总有效率A组100％显著高于B组71.15％ (P＜0.01),优的比率A组88.93％显著高于B组29.81％ (P ＜0.01).结论 急性混合型LEDVT介入治疗好于单纯溶栓效果,尤其在保护静脉瓣膜功能方面明显优于单纯溶栓.
目的 比較介入治療與單純溶栓對急性混閤型下肢深靜脈血栓形成(LEDVT)的療效.方法 迴顧分析解放軍第一四八中心醫院介入血管科1998年4月至2009年12月收治併採用介入取栓與單純溶栓、病程7d內的急性混閤型LEDVT患者458例.A組(327例)機械性血栓抽吸,B組(131例)單純尿激酶溶栓、肝素抗凝.結果 血栓完全清除(Ⅰ級):A組65.44％明顯高于B組37.4％ (P ＜0.01)；齣院時健患肢膝上、下15 cm處週徑差:A組(1.34±0.57)、(0.93 ±0.32)cm好于B組(1.72-0.69)、(1.29-.0.43) cm(均P＜0.01).411例隨訪16 ～ 70箇月,中位隨訪時間35箇月,隨訪率89.83％.術後36箇月患肢膝下15 cm處週徑差,A組(0.53 ±0.22) cm好于B組(1.42±0.65) cm(P ＜0.01)；水腫、色素沉著、潰瘍等後遺癥髮生率,A組29.64％、14.01％、0％；低于B組55.77％、83.65％、9.62％(均P＜0.01)；綵超複查靜脈通暢率和瓣膜功能正常率,A組90.23％、71.34％,均高于B組37.50％、15.38％(均P＜0.01)；總有效率A組100％顯著高于B組71.15％ (P＜0.01),優的比率A組88.93％顯著高于B組29.81％ (P ＜0.01).結論 急性混閤型LEDVT介入治療好于單純溶栓效果,尤其在保護靜脈瓣膜功能方麵明顯優于單純溶栓.
목적 비교개입치료여단순용전대급성혼합형하지심정맥혈전형성(LEDVT)적료효.방법 회고분석해방군제일사팔중심의원개입혈관과1998년4월지2009년12월수치병채용개입취전여단순용전、병정7d내적급성혼합형LEDVT환자458례.A조(327례)궤계성혈전추흡,B조(131례)단순뇨격매용전、간소항응.결과 혈전완전청제(Ⅰ급):A조65.44％명현고우B조37.4％ (P ＜0.01)；출원시건환지슬상、하15 cm처주경차:A조(1.34±0.57)、(0.93 ±0.32)cm호우B조(1.72-0.69)、(1.29-.0.43) cm(균P＜0.01).411례수방16 ～ 70개월,중위수방시간35개월,수방솔89.83％.술후36개월환지슬하15 cm처주경차,A조(0.53 ±0.22) cm호우B조(1.42±0.65) cm(P ＜0.01)；수종、색소침착、궤양등후유증발생솔,A조29.64％、14.01％、0％；저우B조55.77％、83.65％、9.62％(균P＜0.01)；채초복사정맥통창솔화판막공능정상솔,A조90.23％、71.34％,균고우B조37.50％、15.38％(균P＜0.01)；총유효솔A조100％현저고우B조71.15％ (P＜0.01),우적비솔A조88.93％현저고우B조29.81％ (P ＜0.01).결론 급성혼합형LEDVT개입치료호우단순용전효과,우기재보호정맥판막공능방면명현우우단순용전.
Objective To compare the clinical efficacy of interventional thrombectomy versus thrombolytic treatment for acute mixed-type lower extremity deep venous thrombosis (LEDVT).Methods The clinical data of 458 patients with acute mixed type LEDVT were analyzed retrospectively.Group A:327 patients underwent mechanical aspiration thrombectomy; Group B:131 patients received systematic thrombolysis and anticoagulation with urokinase and heparin.Results Complete thrombus removal (Grade Ⅰ):Group A was was better than group B (65.44％ vs 37.4％) (P =0.000).The circumference differences of healthy and affected limbs of knee-joints' below and above 15 cm at discharge were (1.34 ± 0.57) and (0.93 ±0.32) cm in group A were better than (1.72 ±0.69) and (1.29 ±0.43) cm in group B (both P =0.000).Among them,411 patients had a median follow-up period of 35 (16-70) and the follow-up rate was 89.83％.At 36 months postoperation,the circumference difference of affected limbs of knee-joints' below 15 cm for group A (0.53 ±0.22) cm was better than that for group B (1.42 ±0.65) cm (P =0.000).And the sequelae occurrence rates of edema,pigmentation and ulceration of group A (29.64％,14.01％,0％) were lower than those of group B (55.77％,83.65％,9.62％) (both P =0.000).Color Doppler flow imaging revealed that the vein patency rate of group A was 90.23％ and normal valve function rate 71.34％.And both were better than group B (37.50％,15.38％) (P =0.000 ; P =0.000).The total effective rate of group A (100％) was better than that of group B (71.15％) (P =0.000).Excellency rate:group A(88.93％)was higher than group B(29.81％) (P =0.000).Conclusion Interventional thrombectomy is better than simple thrombolysis in the treatment of acute mixed-type lower extremity deep venous thrombosis.And the former offers better protection of normal valve function.
