导管接触性溶栓联合髂静脉支架治疗下肢深静脉血栓形成的疗效及预后分析

  目的  比较导管接触性溶栓联合髂静脉支架植入与外周溶栓治疗下肢深静脉血栓合并髂静脉狭窄的疗效。   方法  回顾性分析2014年12月—2019年12月于安徽医科大学附属第四医院普外科就诊的下肢深静脉血栓合并髂静脉狭窄患者，42例患者中15例行外周溶栓术(系统溶栓组)，27例行导管接触性溶栓或联合髂静脉支架植入术(导管溶栓组)，比较2组并发症、血栓溶解有效率以及血栓后综合征的发生率。   结果  系统溶栓组及导管溶栓组的溶栓剂量分别为(335±134)万U和(304±116)万U，系统溶栓组出现并发症4例，导管溶栓组出现并发症2例，2组溶栓剂量、并发症发生率比较差异无统计学意义(均P>0.05)；系统溶栓组和导管溶栓组的溶栓有效率分别为53.33%和88.89%，导管溶栓组的血栓溶解有效率高于系统溶栓组(P < 0.05)，系统溶栓组和导管溶栓组的Villalta评分分别为2.53分和1.77分，导管溶栓组的血栓后综合征发生率低(P < 0.01)；此外，系统溶栓组VEINES-QOL/Sym分别为35.33分及32.67分，而导管溶栓组VEINES-QOL/Sym分别为49.00分及45.67分，显著高于系统溶栓组(P < 0.01)。   结论  导管接触性溶栓联合髂静脉支架对于下肢深静脉血栓伴有髂静脉狭窄的患者有更好的疗效。 

Efficacy and prognosis of catheter-directed thrombolysis combined with iliac vein stenting for deep vein thrombosis

  Objective  To compare the efficacy between catheter-directed thrombolysis combined with iliac vein stent implantation and peripheral thrombolysis in the treatment of lower extremity deep vein thrombosis with iliac vein stenosis.   Methods  A retrospective analysis was performed on patients diagnosed with deep vein thrombosis combined with iliac vein stenosis in our institution from December 2014 to December 2019. A total of 42 cases were included in this study, 15 of which underwent peripheral thrombolysis (systematic thrombolysis group) and 27 of which received catheter-directed thrombolysis combined with iliac vein stenting (catheter-directed thrombolysis group). Clinical data including complications, effective rate of thrombolysis and incidence of post-thrombotic syndrome were collected and compared between the two groups.   Results  The thrombolytic doses of the systemic thrombolysis group and catheter-directed thrombolysis group were (3.35±1.34) and (3.04±1.16) million U, respectively. Three patients in the systematic thrombolysis group and two patients in the catheter-directed thrombolysis group had complications. No significant difference was observed in the thrombolytic dose and complication rate between the two groups (all P>0.05); the effective rate of thrombolysis in the systemic thrombolytic group was 53.33%, whilst the rate was 88.89% in the catheter-directed thrombolysis group, which was higher than that in the systematic thrombolysis group (P < 0.05). The average Villalta score of the systematic thrombolysis group was 2.53 points, and that of the catheter-directed thrombolysis group was 1.77 points. The incidence of post-thrombotic syndrome was lower in the catheter-directed thrombolysis group than in the systematic thrombolysis group (P < 0.01). In addition, the VEINES-QOL/Sym scores in the systematic thrombolysis group were 35.33 and 32.67 points, whilst those in the catheter-directed thrombolysis group were 49.00 and 45.67 points. The scores were significantly higher in the catheter-directed thrombolysis group than in the systematic thrombolysis group (P < 0.01).   Conclusion  Catheter-directed thrombolysis combined with iliac vein stent has a better curative effect for patients with deep vein thrombosis of lower extremities with iliac vein stenosis.