急性混合型下肢深静脉血栓综合介入治疗与系统溶栓疗效的比较

目的：比较综合介入治疗与系统溶栓治疗对急性混合型下肢深静脉血栓（LEDVT）的疗效。方法：回顾分析12年间收治的229例急性混合型LEDVT患者的临床资料。122例采用血栓碎吸、溶栓等综合介入治疗（A组），其中合并髂静脉狭窄或闭塞53例，采取腔内血管成形术（PTA）和支架植入辅助处理，术后辅以小剂量尿激酶溶栓、肝素抗凝治疗；另107例（B组）行尿激酶，肝素抗凝等系统溶栓治疗。结果：平均住院天数A组（6.2±2.2）d，B组（10.5±2.4）d；2周后复查，A，B两组的治愈率和有效率分别为40.98%，14.02%和96.72%，77.57%，差异均有统计学意义（均P<0.05）。随访12~85个月，患肢膝下15 cm处周径差A组为（0.53±0.42）cm，B组为（1.42±1.35）cm；水肿、色素沉着、溃疡等后遗症发生率A组分别23.15%，9.26%和0，B组分别为50.51%，80.81%和9.09%，A组静脉通畅率为81.48%，静脉瓣膜功能正常率为57.41%，B组为65.66%和15.15%，差异均有统计学意义（P<0.05）。结论：综合介入治疗对急性混合型LEDVT的近期、中远期疗效均优于系统溶栓，尤其在保护静脉瓣膜功能方面明显优于系统溶栓。

Integrated interventional therapy versus systemic thrombolysis for mixed type of acute lower extremity deep venous thrombosis

Objective: To compare the clinical efficacies of integrated interventional therapy and systemic thrombolytic treatment for mixed type of acute lower extremity deep venous thrombosis (DVT). Methods: The clinical data of 458 patients with acute mixed type of lower extremity DVT admitted over 12 years were retrospectively analyzed. One-hundred and twenty-two patients (group A) underwent the integrated interventional therapy that comprised thrombus aspiration and thrombolysis, 53 cases who were complicated with iliac vein compression or obstruction received the auxiliary procedures of percutaneous transluminal angioplasty (PTA) and stent placement, and the other 107 patients (group B) received systemic thrombolytic therapy with urokinase and heparin. Results: The average length of hospital stay for patients in group A was (6.2±2.2) d and in group B was (6.2±2.2) d; the cure rate and effective rate reviewed 2 weeks later in group A was 40.98% and 14.02%, and in group B was 96.72% and 77.57%, respectively, and all differences between the two groups had statistical significance (all P<0.05). During 12–85 months follow-up period, the difference between the diameter of the two legs at 15 cm below knee joint was (0.53±0.42) cm in group A and (1.42±1.35) cm in group B; the incidence of edema, skin pigmentation, and ulceration was 23.15%, 9.26% and 0 in group A, and 50.51%, 80.81% and 9.09% in group B; the rates of vein patency and normal venous valve function were 81.48% and 57.41% in group A, and 65.66% and 15.15% in group B, respectively, and all the differences between the two groups had statistical significance (all P<0.05). Conclusion: Integrated interventional therapy has better short- and mid-term efficacy than systemic thrombolytic therapy for acute mixed type of lower extremity DVT, especially in the aspect of venous valves protection.