Cockett综合征合并急性期血栓的治疗疗效临床分析
发布时间：2018-08-28 07:31
【摘要】：目的:探讨Cockett综合征合并急性下肢深静脉血栓形成(DVT)的不同治疗方法的疗效以及进行CDT治疗时滤器置入是否常规,为临床对Cockett综合征合并急性DVT的治疗寻找更加合理治疗方法。方法:回顾性分析郑州大学第一附属医院2014年8月至2016年4月期间就诊89例Cockett综合征合并急性下肢DVT患者,按治疗方式分为实验组(A组和B组)和对照组(C组),A组36例均行下腔滤器置入+置管溶栓,均进行首次球扩;B组22例均行置管溶栓,不进行首次球扩;C组31例采用行患肢足背静脉泵入溶栓药物进行治疗;三组均辅助抗凝、活血、消肿药物以及穿弹力袜等治疗,比较A、B两组患者血栓溶解程度,肺栓塞发生率评估治疗效果,院外均规律口服华法林至少6个月,远期通过电话、复查彩超或者深静脉顺行造影随访,以静脉严重程度评分以及疗效分级评估观察各组治疗疗效及血栓相关事件发生率。结果:治疗期间,A和B组技术成功率均为100%,均未出现肺栓塞,差异无统计学意义(P0.05),无疾病相关死亡病例,3例出现牙龈出血,鼻出血,血尿调整方案后症状消失;A、B组第3d溶栓疗效比较(Hc=6.646,P=0.01),差异具有统计学意义(P0.05),第7d溶栓疗效比较(Hc=2.186,P=0.139),差异无统计学无意义(P0.05);A组11例行球扩,16例支架置入;B组7例行球扩,11例行支架置入。87例获得随访,随访时间为3-20个月,平均8.9月,支架内2例血栓复发,A、B组有效率均为100%,组间治疗疗效比较(Hc=0.079,P=0.778),差异无统计学意义(P0.05);C组有效率80%;实验组和对照组治疗疗效比较(Hc=13.026,P=0.000),差异具有统计学意义(P0.05);血栓后遗症发生率,实验组明显低于对照组,差异有统计学意义(P0.05);三组治疗方式的VCSS评分比较(χ2=50.226,P=0.000),差异具有统计学意义(P0.05);组间进行两两比较,A组与C组(Z=6.572,P=0.000)、B组与C组(Z=5.311,P=0.000),差异具有统计学意义(P0.05),而A组与B组(Z=0.541,P=0.295),差异无统计学意义(P0.05)。结论:1.对于Cockett综合征合并急性期血栓治疗,腔内治疗较药物系统溶栓效果好,并且具有起效快,创伤小,恢复快,通畅率高,发生血栓后综合征率低;2.对于Cockett综合征合并急性期血栓进行CDT治疗,本实验结果显示滤器组和非滤器组肺栓塞发生无差异,我们中心认为可以不常规置入下腔静脉滤器;3.进行CDT治疗同时,首次给予球囊扩张与不给予球囊扩张比较,溶栓后疗效短第3d有差异,第7d差异不明显,说明首次球扩后能够减少溶栓药物用量,减少出血并发症发生,但远期治疗效果无明显差异。
[Abstract]:Objective: to investigate the curative effect of different treatment methods of Cockett syndrome with acute deep venous thrombosis of lower extremity (DVT) and to find a more reasonable treatment for Cockett syndrome with acute DVT. Methods: a retrospective analysis was made on 89 patients with Cockett syndrome complicated with acute lower limb DVT from August 2014 to April 2016 in the first affiliated Hospital of Zhengzhou University. According to the treatment method, 36 cases of group A were divided into experimental group (group A and group B) and control group (group C). All 36 cases of group A were treated with inferior chamber filter, 22 cases of group B were treated with thrombolytic therapy in group B for the first time. In group C, 31 patients were treated with thrombolytic drugs by injecting thrombolytic drugs into the dorsal vein of affected limbs, and all three groups were treated with anticoagulant, activating blood circulation, anti-swelling drugs and wearing elastic socks, to compare the thrombolysis degree of patients in group A and B, The incidence rate of pulmonary embolism was evaluated. Regular oral warfarin was taken out of hospital for at least 6 months. The patients were followed up by color Doppler ultrasound or deep vein anterograde angiography by telephone in the long term. The therapeutic efficacy and the incidence of thrombus-related events were evaluated by venous severity score and efficacy classification. Results: the technical success rate of group A and B was 100, and there was no significant difference in pulmonary embolism (P0.05). There were 3 cases of gingival bleeding and epistaxis in no disease related death cases. Comparison of thrombolytic efficacy (Hc=6.646,P=0.01) on the 3rd day (P0.05) and 7 days after thrombolytic therapy (Hc=2.186,P=0.139) in group A (P05), there was no significant difference between group A and group A (P0.05). 11 cases underwent stent implantation. 87 cases were followed up. The follow-up period was 3 to 20 months, with an average of 8.9 months. The effective rate of two patients with thrombus recurrence in stent group B was 100. There was no significant difference (P 0.05) between the two groups (P 0.05). The effective rate of group C was 80%, while that of experimental group and control group (Hc=13.026,P=0.000) was statistically significant (P0.05), the incidence of thrombotic sequelae was significantly higher than that of control group (P 0.05), while that of control group was significantly higher than that of control group (P 0.05). The experimental group was significantly lower than the control group. The difference was statistically significant (P0.05); the VCSS score of the three groups was significantly different (蠂 2: 50.226P 0.000), the difference was statistically significant (P0.05); the difference between group A and group C was statistically significant (P0.05); the difference between group B and group C was statistically significant (P0.05), but the difference between group A and group B (0.295) was not significant (P0.05). Conclusion 1. For Cockett syndrome combined with acute thrombus therapy, endovascular therapy is better than drug system thrombolytic effect, and has quick effect, little trauma, quick recovery, high patency rate and low rate of post-thrombotic syndrome. For the treatment of Cockett syndrome with acute thrombus, the results show that there is no difference between the filter group and the non-filter group. We believe that the inferior vena cava filter can be placed unroutinely. At the same time, compared with non-balloon dilatation and the first balloon dilatation, the effect of thrombolytic therapy was shorter in the third day than that in the seventh day, which indicated that the dosage of thrombolytic drugs could be reduced and the complications of bleeding could be reduced after the first balloon expansion. But there was no significant difference in long-term therapeutic effect.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.6
本文编号：2208711
[Abstract]:Objective: to investigate the curative effect of different treatment methods of Cockett syndrome with acute deep venous thrombosis of lower extremity (DVT) and to find a more reasonable treatment for Cockett syndrome with acute DVT. Methods: a retrospective analysis was made on 89 patients with Cockett syndrome complicated with acute lower limb DVT from August 2014 to April 2016 in the first affiliated Hospital of Zhengzhou University. According to the treatment method, 36 cases of group A were divided into experimental group (group A and group B) and control group (group C). All 36 cases of group A were treated with inferior chamber filter, 22 cases of group B were treated with thrombolytic therapy in group B for the first time. In group C, 31 patients were treated with thrombolytic drugs by injecting thrombolytic drugs into the dorsal vein of affected limbs, and all three groups were treated with anticoagulant, activating blood circulation, anti-swelling drugs and wearing elastic socks, to compare the thrombolysis degree of patients in group A and B, The incidence rate of pulmonary embolism was evaluated. Regular oral warfarin was taken out of hospital for at least 6 months. The patients were followed up by color Doppler ultrasound or deep vein anterograde angiography by telephone in the long term. The therapeutic efficacy and the incidence of thrombus-related events were evaluated by venous severity score and efficacy classification. Results: the technical success rate of group A and B was 100, and there was no significant difference in pulmonary embolism (P0.05). There were 3 cases of gingival bleeding and epistaxis in no disease related death cases. Comparison of thrombolytic efficacy (Hc=6.646,P=0.01) on the 3rd day (P0.05) and 7 days after thrombolytic therapy (Hc=2.186,P=0.139) in group A (P05), there was no significant difference between group A and group A (P0.05). 11 cases underwent stent implantation. 87 cases were followed up. The follow-up period was 3 to 20 months, with an average of 8.9 months. The effective rate of two patients with thrombus recurrence in stent group B was 100. There was no significant difference (P 0.05) between the two groups (P 0.05). The effective rate of group C was 80%, while that of experimental group and control group (Hc=13.026,P=0.000) was statistically significant (P0.05), the incidence of thrombotic sequelae was significantly higher than that of control group (P 0.05), while that of control group was significantly higher than that of control group (P 0.05). The experimental group was significantly lower than the control group. The difference was statistically significant (P0.05); the VCSS score of the three groups was significantly different (蠂 2: 50.226P 0.000), the difference was statistically significant (P0.05); the difference between group A and group C was statistically significant (P0.05); the difference between group B and group C was statistically significant (P0.05), but the difference between group A and group B (0.295) was not significant (P0.05). Conclusion 1. For Cockett syndrome combined with acute thrombus therapy, endovascular therapy is better than drug system thrombolytic effect, and has quick effect, little trauma, quick recovery, high patency rate and low rate of post-thrombotic syndrome. For the treatment of Cockett syndrome with acute thrombus, the results show that there is no difference between the filter group and the non-filter group. We believe that the inferior vena cava filter can be placed unroutinely. At the same time, compared with non-balloon dilatation and the first balloon dilatation, the effect of thrombolytic therapy was shorter in the third day than that in the seventh day, which indicated that the dosage of thrombolytic drugs could be reduced and the complications of bleeding could be reduced after the first balloon expansion. But there was no significant difference in long-term therapeutic effect.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.6
【参考文献】
相关期刊论文 前1条
1 张福先;杨子明;;关于腔静脉滤器临床应用的若干问题——专家观点与基本共识[J];中华外科杂志;2010年24期
，本文编号：2208711
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