支架植入在AngioJet吸栓治疗下肢深静脉血栓中的应用研究-东南大学学报医学版

支架植入在AngioJet吸栓治疗下肢深静脉血栓中的应用研究

单位：上海市普陀区中心医院血管外科, 上海 200062

分类号：R543.6;R605

出版年·卷·期（页码）：2019·38·第六期（967-971）

摘要：

目的：评价AngioJet吸栓在治疗下肢静脉血栓（DVT）中的疗效，探讨支架植入在AngioJet吸栓治疗中的应用。方法：回顾性分析2017年1月至2018年11月我院收治的60例DVT患者的临床资料，通过分析采用AngioJet吸栓治疗且植入支架的患者（研究组）及传统AngioJet吸栓治疗的患者（对照组）的溶栓时间、尿激酶用量、血栓清除率以及患侧与健侧腿围之差（周径差）变化等指标，评估两组患者的疗效。结果：两组DVT患者均手术成功，研究组和对照组的血栓清除率达到Ⅲ级的比例分别为66.7%和56.7%；两组患者手术后1d和7 d的膝上腿围、膝下腿围的周径差均明显降低（P < 0.05），且研究组比对照组的周径差降低更明显（P < 0.05）。随访中研究组的支架通畅率为93.3%。两组手术后出血、血红蛋白尿和肾功能衰竭等不良反应发生率均较低，且两组差异无统计学意义（P > 0.05）。结论：AngioJet血栓抽吸是治疗DVT安全有效的手段，支架的植入在AngioJet血栓抽吸治疗DVT过程中起到了积极的作用。

Objective: To evaluate the efficacy of AngioJet thrombectomy in the treatment of deep venous thrombosis (DVT), and to explore the application of stent implantation in AngioJet thrombectomy. Methods: Clinical data of 60 patients with DVT admitted to our hospital from January 2017 to November 2018 were analyzed retrospectively. The efficacy was evaluate by analyzing the thrombolytic time, urokinase dose, thrombus clearance rate, and change of leg circumference of the patients treated with AngioJet thrombectomy combing stent implantation (study group) and the patients treated with traditional AngioJet thrombectomy (control group). Results: The operation for all the patients with DVT were successfully. The proportion of thrombus clearance in the study group and the control group reached Grade Ⅲ were 66.7% and 56.7%, respectively. The difference of upper leg circumference and the lower leg circumference were reduced significantly (P < 0.05) at 1th and 7th days after surgery, and the circumference difference of the study group's had greater decreases(P < 0.05). The stent patency rate of the study group was 93.3% during the follow-up. The adverse reactions such as postoperative bleeding, hemoglobinuria and renal failure were lower in the two groups and there was no significant difference between the two groups(P > 0.05). Conclusion: AngioJet thrombectomy is a safe and effective method in the treatment of patients with DVT. The implantation of the stent plays an active role in the treatment of DVT by AngioJet thrombectomy.

参考文献：

[1] 赵国瑞,任建庄,段旭华,等.腔内介入治疗Cockett综合征伴左下肢深静脉血栓形成[J].介入放射学杂志,2017,26(6):522-526.
[2] 秦锋,李斌本,张雷,等.机械血栓抽吸结合台上溶栓治疗急性下肢深静脉血栓形成[J].中华普通外科杂志,2017,32(3):224-227.
[3] HUANG C Y,HSU H L,KUO T R,et a1.Percutaneous pharmacomechanical thrombectomy offers lower risk of postthrombotic syndrome than catheter-directed thrombolysis in patients with acute deep vein thrombosis of the lower limb[J].Ann Vasc Surg,2015,29(5):995-1002.
[4] 王宾,于振海,王坤,等.AngioJet机械吸栓与导管接触性溶栓在治疗急性下肢深静脉血栓形成中的对比分析[J].血管与腔内血管外科杂志,2017,3(5):931-933,925.
[5] 黄晨,陈汉威.下肢深静脉血栓的介入治疗研究进展[J].中华介入放射学电子杂志,2017,5(2):70-73.
[6] LIU G,QIN J,CUI C,et al.Comparison of direct iliofemoral stenting following AngioJet rheolytic thrombectomy vs staged stenting after angiojet rheolytic thrombectomy plus catheter-directed thrombolysis in patients with acute deep vein thrombosis[J].Endovasc Ther,2018,25(1):133-139.
[7] LIN P H,ZHOU W,DARDIK A,et al.Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis[J].Am J Surg,2006,192(6):782-788.
[8] 陆浩,葛均波.AngioJet机械血栓抽吸装置在急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗中的应用[J].上海医学,2013,36(9):746-748.
[9] GARCIA M J,LOOKSTEIN R,MALHOTRA R,et al.Endovascular management of deep vein thrombosis with rheolytic thrombectomy:final report of the prospective multicenter PEARL (peripheral use of Angio Jet rheolytic thrombectomy with a variety of catheter lengths) registry[J].J Vasc Interv Radiol,2015,26(6):777-785.
[10] 《血管与腔内血管外科杂志》编辑部,下肢静脉疾病外科治疗专家协作组.AngioJet机械血栓清除术治疗急性下肢深静脉血栓形成的专家共识(2016版)[J].血管与腔内血管外科杂志,2017,3(1):555-558.
[11] KNIPP B S,FERGUSON E,WILLIAMS D M,et al.Factors associated with outcome after interventional treatment of symptomatic iliac vein compression syndrome[J].J Vasc Surg,2007,46(4):743-749.
[12] 杨建平,慈红波,方青波,等.腔内治疗左髂静脉受压综合征并急性髂-股静脉血栓形成临床分析[J].中国血管外科杂志(电子版),2016,8(2):142-145.
[13] 王瑶,张永庆,路蓉.下肢深静脉血栓介入治疗中超声血管增强技术联合全景超声成像的质量评价[J].现代医学,2018,46(1):50-53.

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