中国普外基础与临床杂志

中国普外基础与临床杂志

AngioJet 机械吸栓辅助治疗急性下肢深静脉血栓形成

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目的 评价 AngioJet 机械吸栓(percutaneous mechanical thrombectomy,PMT)治疗急性下肢深静脉血栓形成(deep venous thrombosis,DVT)的疗效。 方法 回顾性分析青岛市市立医院血管外科于 2015 年 12 月至 2018 年 6 月期间收治的行 AngioJet 机械吸栓治疗的 72 例(72 条肢体)急性下肢 DVT 患者的临床资料。 结果 例行 PMT 治疗,42 例行 PMT 联合导管接触性溶栓(catheter directed thrombolysis,CDT)治疗。结果Ⅲ级溶栓 49 例(68.05%),Ⅱ级溶栓 20 例(27.78%),Ⅰ级溶栓 3 例(4.17%);35 例合并左髂静脉压迫综合征者,置入髂静脉支架 34 例,术中并发髂静脉破裂出血 1 例。术后 3 个月、6 个月、1 年及 2 年随访患者的 PTS 发生率分别为 1.41%(1/71)、3.58%(2/56)、4.55%(2/44)及 20.00%(3/15);术后 1 年和 2 年,随访患者的髂股静脉通畅率分别为 86.36%(38/44)和 80.00%(12/15),髂静脉支架通畅率分别为 100%(23/23)和 87.50%(7/8)。 结论 机械吸栓辅以 CDT 治疗急性下肢 DVT 的疗效满意,远期效果尚待进一步观察。

objective To evaluate the effect of percutaneous mechanical thrombectomy (PMT) with AngioJet mechanical thrombus aspiration system for the acute deep venous thrombosis (DVT) of lower extremities. Methods The clinical data of 72 patients (72 limbs) with acute DVT who underwent PMT with AngioJet system from December 2015 to June 2018 in our hospital were analyzed retrospectively. Results Of the 72 cases, 30 cases underwent PMT alone, while 42 cases underwent PMT combined with catheter directed thrombolysis (CDT). Thrombus clearance rate of grade Ⅲ was obtained in 49 cases (68.05%), grade Ⅱ in 20 cases (27.78%), and grade Ⅰ in 3 cases (4.17%). Thirty-five cases were found with May-Thurner syndrome, and 34 cases were treated with stenting while 1 complicating with iliac bleeding. The rates of PTS were 1.41% (1/71), 3.58% (2/56), 4.55% (2/44), and 20.00% (3/15) at 3-month, 6-month, 1-year, and 2-year after intervention, respectively. The deep vein patency rates were 86.36% (38/44) and 80.00% (12/15) at 1-year and 2-year after intervention, respectively. The iliac stent patency rates were 100% (23/23) and 87.50% (7/8) at 1-year and 2-year after intervention, respectively. Conclusion The effect of PMT assisted with CDT for the acute DVT of lower extremities is satisfactory, but its long-term efficacy needs to be further observed.

关键词: 深静脉血栓; 下肢; 机械吸栓; 导管接触性溶栓

Key words: deep venous thrombosis; lower extremity; mechanical thrombectomy; catheter directed thrombolysis

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