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目的探讨腔静脉滤器置入联合导管直接溶栓治疗下肢深静脉血栓形成(DVT)的疗效。方法回顾性分析2008年1月至2009年8月期间我科收治的65例病程≤7d的中央型和混合型下肢DVT患者的临床资料,其中32例采用腔静脉滤器置入联合导管直接溶栓,同时行常规抗凝、活血化瘀等治疗,设为研究组;33例给予常规溶栓、抗凝以及活血化瘀等治疗,设为对照组。比较2组患者的疗效。结果研究组患者治疗前双侧肢体周径差为(7.35±1.42)cm,治疗后3、7和14d双侧肢体周径差分别为(4.21±1.12)cm、(2.87±0.98)cm和(1.22±1.02)cm,治疗前与治疗后不同时间段比较差异有统计学意义(P<0.01);对照组治疗前双侧肢体周径差为(6.97±1.27)cm,治疗后3、7和14d双侧肢体周径差分别为(5.72±1.31)cm、(4.58±0.88)cm和(3.18±1.24)cm,治疗前与治疗后各时间段比较差异也有统计学意义(P<0.05或P<0.01)。2组患者治疗前双侧肢体周径差的差异无统计学意义(P>0.05)。2组患者组内治疗后不同时间段双侧肢体周径差的差异有统计学意义(P<0.01)。研究组治疗后不同时间段双侧肢体周径差均显著低于对照组相应时间段(P<0.01);14d后,研究组髂-股静脉完全再通率(71.88%,23/32)和临床治愈率(71.88%,23/32)均显著高于对照组(均为36.36%,12/33),P<0.01;无一例发生肺栓塞。结论从下肢DVT理想治疗目标角度看,腔静脉滤器置入联合导管直接溶栓治疗效果优于传统溶栓治疗。
Objective To investigate the curative effect of vena cava filter placement combined with direct catheter thrombolysis in the treatment of deep vein thrombosis (DVT). Methods The clinical data of 65 patients with central and mixed lower extremity DVT with a duration of less than 7 days admitted from January 2008 to August 2009 in our department were analyzed retrospectively. Thirty-two cases were treated with venous thrombectomy , While conventional anticoagulant, blood circulation and other treatment, as the study group; 33 cases given conventional thrombolytic, anticoagulant and blood circulation and other treatment, as the control group. Compare the efficacy of two groups of patients. Results The difference of bilateral limb circumference before treatment in study group was (7.35 ± 1.42) cm, and the difference of bilateral limb circumference at 3, 7 and 14 days after treatment was (4.21 ± 1.12) cm, (2.87 ± 0.98) cm and 1.22 ± 1.02) cm, there was significant difference between before treatment and after treatment (P <0.01). The difference of bilateral limb circumference before treatment was (6.97 ± 1.27) cm in control group, The differences of the peripheral diameters of the two limbs on the 14th day were (5.72 ± 1.31) cm, (4.58 ± 0.88) cm and (3.18 ± 1.24) cm, respectively. There were also significant differences between before and after treatment (P <0.05 or P <0.01). There was no significant difference in the difference of biopsy volume between the two groups before treatment (P> 0.05). There was significant difference in the difference of bilateral limb circumference between two groups after treatment (P <0.01). After 14 days of treatment, the difference in bilateral limb circumference between the two groups was significantly lower than that of the control group (P <0.01). After 14 days, the complete recanalization rates of iliac-femoral vein (71.88%, 23/32) and The clinical cure rate (71.88%, 23/32) was significantly higher than that of the control group (both 36.36%, 12/33), P <0.01. No pulmonary embolism occurred. Conclusions From the perspective of the ideal target of DVT for lower extremity, the direct thrombolysis of the vena cava filter into the catheter is superior to the traditional thrombolytic therapy.