CAJ | 학술논문

目的：对比局部置管溶栓和外周静脉溶栓治疗在下腔静脉滤器血栓形成中的溶栓疗效，缩短滤器植入时间，提高滤器取出率，降低滤器永久植入后中远期合并症。方法采用单中心前瞻性研究的方法，收集2013年2月至2014年8月期间北京积水潭医院血管外科收治的创伤性下肢骨折合并深静脉血栓并放置可回收性腔静脉滤器（OptEase）的患者，下腔静脉造影或彩超发现滤器下血栓≥1.0 cm者，采用随机数字表法分组，进行外周溶栓或导管溶栓治疗，对滤器的取出率进行对比分析讨论。结果外周溶栓组30例，滤器取出11例，取出率36.7％，导管溶栓组30例，滤器取出24例，取出率80.0％，导管溶栓组取出率明显高于外周溶栓取出率（P＜0.05）；两组间溶栓治疗后血栓大小变化的对比，导管溶栓组的溶栓效果优于外周溶栓组（P＜0.05）。滤器取出后无再发肺栓塞表现。结论在下腔静脉滤器血栓形成中局部置管溶栓效果明显优于外周静脉溶栓治疗。
목적：대비국부치관용전화외주정맥용전치료재하강정맥려기혈전형성중적용전료효，축단려기식입시간，제고려기취출솔，강저려기영구식입후중원기합병증。방법채용단중심전첨성연구적방법，수집2013년2월지2014년8월기간북경적수담의원혈관외과수치적창상성하지골절합병심정맥혈전병방치가회수성강정맥려기（OptEase）적환자，하강정맥조영혹채초발현려기하혈전≥1.0 cm자，채용수궤수자표법분조，진행외주용전혹도관용전치료，대려기적취출솔진행대비분석토론。결과외주용전조30례，려기취출11례，취출솔36.7％，도관용전조30례，려기취출24례，취출솔80.0％，도관용전조취출솔명현고우외주용전취출솔（P＜0.05）；량조간용전치료후혈전대소변화적대비，도관용전조적용전효과우우외주용전조（P＜0.05）。려기취출후무재발폐전새표현。결론재하강정맥려기혈전형성중국부치관용전효과명현우우외주정맥용전치료。
Objective To assess the effectiveness of improving the filter retrieval rate by catheter-directed thrombolysis compared with systemic thrombolysis in patients presented with stent thrombosis after inferior vena cava filters implantation.Methods This was a prospective,randomized,parallel group,single-center clinical study conducted in Beijing Jishuitan Hospital.Sixty subjects implanted with OptEase retrievable filters due to deep venous thrombosis (DVT)secondary to traumatic lower limb fracture seen from February 201 3 to August 201 4 were enrolled in this study.All subjects were diagnosed with stent thrombosis at least 1.0 cm in diameter by infeior vena cava angiography or color Doppler ultrasound.Subjects were randomized to receive catheter-directed thrombolysis or peripheral intravenous thrombolysis for six days.The primary study endpoint was the filter retrieval rate.Results The filter retrieval rate was 80%(24/30)in catheter-directed thrombolysis group compared with 36.7%(1 1/30)in the control group,the difference was statistically significant (P<0.05 ).The efficacy of thrombolysis was superior in the catheter-direct thrombolysis group based on the change of the size of thrombus after treatment compared to the baseline (P<0.05 ).No subjects experienced pulmonary embolism in follow-up period.Conclusion Compared with systemic thrombolysis,catheter-directed thrombolysis provided better efficacy in terms of increasing the rate of filter retrieval after stent obstruction.