多途径CDT治疗混合型急性下肢深静脉血栓形成的疗效分析

发布时间：2018-04-08 16:39

  本文选题：深静脉血栓形成　切入点：导管溶栓　出处：《南昌大学》2016年硕士论文

【摘要】：目的:回顾分析混合型急性下肢深静脉血栓形成经不同入路置管溶栓的疗效。方法:收集2012年1月-2015年12月118例混合型急性下肢深静脉血栓形成患者的住院及随访资料,将其分为A、B、C三组,A组含经健侧股静脉穿刺置管23例、B组含切开或经皮小隐静脉穿刺置管30例、C组含经皮穿刺胫前或胫后静脉置管65例,分别比较三组病人溶栓手术前后疗效差异、三组间术后疗效差异、手术并发症、远期随访PTS发生率差异。评价指标包括手术前后大腿、小腿周径差,患肢消肿率,手术前后深静脉通畅度评分,血栓清除率、手术完成时间,手术并发症及术后2年随访PTS发生率等。结果:1、A组:手术前后患、健侧大腿周径差分别为(5.53±0.42)cm及(1.78±0.53)cm,差异有统计学意义(t=4.63,P0.05);手术前后患、健侧小腿周径差分别为(4.96±0.54)cm及(2.13±0.65)cm,差异有统计学意义(t=3.32,P0.05);手术前后静脉通畅度评分分别为(8.95±1.63)分及(4.26±1.26)分,差异有统计学意义(t=6.37,P0.05);B组:手术前后患、健侧大腿周径差分别为(5.46±0.38)cm及(1.85±0.68)cm,差异有统计学意义(t=4.68,P0.05);手术前后患、健侧小腿周径差分别为(4.81±0.45)cm及(1.75±0.59)cm,差异有统计学意义(t=3.16,P0.05);手术前后静脉通畅度评分分别为(8.77±1.43)分及(3.27±1.59)分,差异有统计学意义(t=6.43,P0.05);C组:手术前后患、健侧大腿周径差分别为(5.67±0.46)cm及(1.72±0.56)cm,差异有统计学意义(t=4.63,P0.05);手术前后患、健侧小腿周径差分别为(5.03±0.64)cm及(1.72±0.62)cm,差异有统计学意义(t=3.32,P0.05);手术前后静脉通畅度评分分别为(8.35±1.78)分及(3.35±1.38)分,差异有统计学意义(t=6.28,P0.05)。溶栓术后,三组患者肢体肿胀程度及静脉通畅评分较溶栓术前明显改善。2、A、B、C三组溶栓术后患、健侧大腿周径差分别为(1.78±0.53)cm、(1.85±0.68)cm、(1.72±0.56)cm,差异无统计学意义(F=0.51,P0.05);患肢大腿消肿率(70.72±15.67)%、(68.39±17.25)%、(73.95±17.33)%,差异无统计学意义(F=1.17,P0.05)。三组溶栓术后患、健侧小腿周径差分别为(2.13±0.65)cm、(1.75±0.59)cm、(1.72±0.62)cm,差异显著(F=3.91,P0.05);患肢小腿消肿率(55.82±17.63)%、(66.28±18.26)%、(67.95±17.32)%,差异显著(F=4.11,P0.05);组间比较B组、C组小腿疗效优于A组,B组、C组疗效相似。三组血栓清除率评分分别为(2.55±0.16)分、(2.68±0.19)分、(2.65±0.20)分,差异有统计学意义(F=3.31,P0.05);术后静脉通畅度评分分别为(4.26±1.26)分、(3.27±1.59)分、(3.35±1.38)分,差异有统计学意义(F=3.59,P0.05);手术时间分别为(65.27±5.42)min、(69.36±4.19)min、(52.33±4.25)min,差异显著(F=174.43,P0.05);组间比较B组、C组血栓清除率及静脉通畅评分高于A组,B组、C组无差别,手术时间C组A组B组。留置溶栓导管天数分别为(7.37±1.35)d、(6.25±1.48)d、(6.42±1.39)d,差异显著(F=4.87,P0.05);尿激酶总量统计结果分别为(435.30±56.45)万IU、(383.59±52.39)万IU、(375.35±58.20)万IU,差异显著(F=9.77,P0.05);组间比较B组、C组留置溶栓导管天数及尿激酶总用量少于A组,B组、C组无明显差别。3、三组手术并发症比较:A组出现4例,发生率17.4%;B组出现6例,发生率20%;C组出现10例,发生率为15.4%,差异无统计学意义(x~2=0.32,P0.05)。4、118例患者术后完成随访101例,失仿17例,随访率85.59%,随访时间3—24个月(中位时间20.4个月)。83例髂静脉受压综合征患者,植入支架83枚,失仿10例。73例植入支架患者,2年通畅率为89.04%。其中发生支架再狭窄5例,3例出现支架狭窄合并血栓形成。PTS发生率分别为:A组随访20例发生8例,发生率40%;B组随访24例发生3例,发生率12.50%;C组随访57例发生8例,发生率14.04%,差异有统计学意义(x~2=7.36,P0.05),其中B、C组PTS发生率无明显差异且低于A组。A、B、C三组PTS评分分别为(6.36±1.35)分、(4.53±1.56)分、(4.28±1.23)分,差异有统计学意义(F=20.90,P0.00),其中B、C无明显差异且低于A组。血栓复发率A组随访20例发生2例,发生率10.00%;B组随访24例发生2例,发生率8.33%;C组随访57例发生4例,发生率7.02%,差异有统计学意义(x~2=0.19,P0.05),总的血栓复发率为7.92%。结论:1、经皮穿刺胫前或胫后静脉置管溶栓效果好、手术时间短、操作简便,其他手术入路可做为备选方案。2、三组不同入路置管溶栓治疗急性下肢DVT疗效显著、手术并发症少,2年随访血栓复发率、PTS发生率低。顺行置管溶栓治疗下肢DVT疗效优于逆行置管溶栓,PTS发生率更低。3、PTA联合支架植入术治疗IVCS疗效确切,2年通畅率高。
[Abstract]:Objective: To review the mixed type of acute lower extremity deep vein thrombosis by different approaches of the efficacy of thrombolysis. Method: patients in hospitalization and follow-up data were collected in January 2012 -2015 year in December 118 cases of mixed type of acute lower extremity deep venous thrombosis, which can be divided into A, B, C three group, A group with 23 cases of tube the contralateral femoral vein puncture, group B with open or percutaneous small saphenous vein catheterization in 30 cases, C group with percutaneous anterior or posterior tibial vein catheterization in 65 cases, were compared between three groups before and after surgery in patients receiving thrombolytic efficacy, complications difference, postoperative curative effect between the three groups, long-term the follow-up of PTS incidence were compared. Evaluation indexes include before and after surgery, thigh, calf circumference difference, limb swelling rate, before and after the surgery of deep venous patency score, thrombus removal rate, operation time, postoperative complications and postoperative follow-up of 2 years. Results: the incidence rate of PTS 1, A group: patients before and after surgery, rehabilitation lateral thigh 鍛ㄥ緞宸�鍒嗗埆涓�(5.53卤0.42)cm鍙，

本文编号：1722443