• 川北醫(yī)學(xué)院附屬醫(yī)院血管外科（四川南充 637000）;

目的 探討腔靜脈濾器置入聯(lián)合導(dǎo)管直接溶栓治療下肢深靜脈血栓形成（DVT）的療效。
方法 回顧性分析2008年1月至2009年8月期間我科收治的65例病程≤7 d的中央型和混合型下肢DVT患者的臨床資料，其中32例采用腔靜脈濾器置入聯(lián)合導(dǎo)管直接溶栓，同時行常規(guī)抗凝、活血化瘀等治療，設(shè)為研究組; 33例給予常規(guī)溶栓、抗凝以及活血化瘀等治療，設(shè)為對照組。比較2組患者的療效。
結(jié)果 研究組患者治療前雙側(cè)肢體周徑差為（7.35±1.42） cm，治療后3、7和14 d雙側(cè)肢體周徑差分別為（4.21±1.12） cm、（2.87±0.98） cm和（1.22±1.02） cm，治療前與治療后不同時間段比較差異有統(tǒng)計(jì)學(xué)意義（P lt;0.01）； 對照組治療前雙側(cè)肢體周徑差為（6.97±1.27） cm，治療后3、7和14 d雙側(cè)肢體周徑差分別為（5.72±1.31） cm、（4.58±0.88） cm和（3.18±1.24） cm，治療前與治療后各時間段比較差異也有統(tǒng)計(jì)學(xué)意義（P lt;0.05或P lt;0.01）。2組患者治療前雙側(cè)肢體周徑差的差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。2組患者組內(nèi)治療后不同時間段雙側(cè)肢體周徑差的差異有統(tǒng)計(jì)學(xué)意義（P lt;0.01）。研究組治療后不同時間段雙側(cè)肢體周徑差均顯著低于對照組相應(yīng)時間段（P lt;0.01）; 14 d后，研究組髂股靜脈完全再通率(71.88%,23/32)和臨床治愈率（71.88%,23/32）均顯著高于對照組(均為36.36%,12/33),P lt;0.01; 無一例發(fā)生肺栓塞。
結(jié)論 從下肢DVT理想治療目標(biāo)角度看，腔靜脈濾器置入聯(lián)合導(dǎo)管直接溶栓治療效果優(yōu)于傳統(tǒng)溶栓治療。

引用本文： 鄭江華,武國,朱彥彬,陳興林,陳開. 腔靜脈濾器置入聯(lián)合導(dǎo)管直接溶栓治療下肢深靜脈血栓形成臨床分析. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(7): 679-682. doi: 復(fù)制

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1. Barrett J, Hamilton W. Malignancy and deep vein thrombosis [J]. Br J Gen Pract, 2006; 56(532): 886.
2. Baldwin ZK, Comerota AJ, Schwartz LB. Catheterdirected thrombolysis for deep venous thrombosis [J]. Vasc Endovasc Surg, 2004; 38 (1): 19.
3. Lilienfeld DE, Chan E, Ehland J, et al. Mortality from pulmonary embolism in the United States: 1962 to 1984 [J]. Chest, 1990; 98(5): 10671072.
4. Comerota AJ, Kagan SA. Catheterdirected thrombolysis for the treatment of acute iliofemoral deep venous thrombosis [J]. Phlebology, 2000; 15(2): 149155.
5. Saarinen J, Kallio T, Lehto M, et al. The occurrence of the postthrombotic changes after an acute deep venous thrombosis. A prospective twoyear followup study [J]. J Cardiovasc Surg (Torino), 2000; 41(3): 441446.
6. Meissner MH. Thrombolytic therapy for acute deep venous thrombosis and the venous registry [J]. Rev Cardiovasc Med, 2002; 3 Suppl 2: S53S60.
7. Bergqvist D, Lindholm C, Nelzén O. Chronic leg ulcers: the impact of venous disease [J]. J Vasc Surg, 1999; 29(4): 752755.
8. 王玉琦, 史振宇. 我國血管外科的現(xiàn)狀與展望 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(6): 387389.
9. 馬玉奎, 趙紀(jì)春, 胡志, 等. 下肢深靜脈血栓形成的診斷及綜合治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 5658.
10. 陳鴻強(qiáng), 李光新, 許崇恩, 等. 急性下肢深靜脈血栓形成的溶栓治療分析（附126例報告） [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(6): 665667.
11. 華積德. 現(xiàn)代普通外科學(xué) [M]. 北京: 人民軍醫(yī)出版社, 1999: 287288.
12. 張柏根. 下肢深靜脈血栓形成治療和預(yù)后的幾個問題 [J]. 中華普通外科雜志, 2006; 21(2): 8183.
13. Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheterdirected thrombolysis [J]. Radiology, 1994; 191(2): 487494.
14. 蔣勁松, 施敦, 張成武, 等. 抗凝溶栓聯(lián)合用藥治療急性下肢深靜脈血栓 [J]. 浙江實(shí)用醫(yī)學(xué), 2004; 9(6): 391392, 401.
15. Enden T, Klw NE, Sandvik L, et al. Catheterdirected thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on shortterm patency [J]. J Thromb Haemost, 2009; 7(8): 12681275.
16. Mewissen MW, Seabrook GR, Meissner MH, et al. Catheterdirected thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry [J]. Radiology, 1999; 211(1): 3949.
17. 張精勇, 金星, 吳學(xué)君, 等. 濾器保護(hù)下置管溶栓治療下肢深靜脈血栓形成臨床總結(jié) [J]. 中國實(shí)用外科雜志, 2006; 26(10): 774776.
18. Comerota AJ, Throm RC, Mathias SD, et al. Catheterdirected thrombolysis for iliofemoral deep venous thrombosis improves healthrelated quality of life [J]. J Vasc Surg, 2000; 32(1): 130137.
19. Lin PH, 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.
20. Alesh I, Kayali F, Stein PD. Catheterdirected thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review [J]. Catheter Cardiovasc Interv, 2007; 70(1): 143148.
21. Kasirajan K, Milner R, Chaikof EL. Combination therapies for deep venous thrombosis [J]. Semin Vasc Surg, 2006; 19(2): 116121.
22. 黃曉鐘, 張紀(jì)蔚, 梁衛(wèi), 等. 介入腔內(nèi)溶栓治療急性下肢深靜脈血栓形成 [J]. 介入放射學(xué)雜志, 2006; 15(10): 592596.
23. 李國劍, 楊國凱, 何曉明, 等. 下腔靜脈濾器在治療下肢深靜脈血栓中的應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(11): 922924.
24. Greenfild LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters [J]. J Vasc Surg, 2001; 33(3): 510514.
  1. 1. Barrett J, Hamilton W. Malignancy and deep vein thrombosis [J]. Br J Gen Pract, 2006; 56(532): 886.
  2. 2. Baldwin ZK, Comerota AJ, Schwartz LB. Catheterdirected thrombolysis for deep venous thrombosis [J]. Vasc Endovasc Surg, 2004; 38 (1): 19.
  3. 3. Lilienfeld DE, Chan E, Ehland J, et al. Mortality from pulmonary embolism in the United States: 1962 to 1984 [J]. Chest, 1990; 98(5): 10671072.
  4. 4. Comerota AJ, Kagan SA. Catheterdirected thrombolysis for the treatment of acute iliofemoral deep venous thrombosis [J]. Phlebology, 2000; 15(2): 149155.
  5. 5. Saarinen J, Kallio T, Lehto M, et al. The occurrence of the postthrombotic changes after an acute deep venous thrombosis. A prospective twoyear followup study [J]. J Cardiovasc Surg (Torino), 2000; 41(3): 441446.
  6. 6. Meissner MH. Thrombolytic therapy for acute deep venous thrombosis and the venous registry [J]. Rev Cardiovasc Med, 2002; 3 Suppl 2: S53S60.
  7. 7. Bergqvist D, Lindholm C, Nelzén O. Chronic leg ulcers: the impact of venous disease [J]. J Vasc Surg, 1999; 29(4): 752755.
  8. 8. 王玉琦, 史振宇. 我國血管外科的現(xiàn)狀與展望 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(6): 387389.
  9. 9. 馬玉奎, 趙紀(jì)春, 胡志, 等. 下肢深靜脈血栓形成的診斷及綜合治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 5658.
  10. 10. 陳鴻強(qiáng), 李光新, 許崇恩, 等. 急性下肢深靜脈血栓形成的溶栓治療分析（附126例報告） [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(6): 665667.
  11. 11. 華積德. 現(xiàn)代普通外科學(xué) [M]. 北京: 人民軍醫(yī)出版社, 1999: 287288.
  12. 12. 張柏根. 下肢深靜脈血栓形成治療和預(yù)后的幾個問題 [J]. 中華普通外科雜志, 2006; 21(2): 8183.
  13. 13. Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheterdirected thrombolysis [J]. Radiology, 1994; 191(2): 487494.
  14. 14. 蔣勁松, 施敦, 張成武, 等. 抗凝溶栓聯(lián)合用藥治療急性下肢深靜脈血栓 [J]. 浙江實(shí)用醫(yī)學(xué), 2004; 9(6): 391392, 401.
  15. 15. Enden T, Klw NE, Sandvik L, et al. Catheterdirected thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on shortterm patency [J]. J Thromb Haemost, 2009; 7(8): 12681275.
  16. 16. Mewissen MW, Seabrook GR, Meissner MH, et al. Catheterdirected thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry [J]. Radiology, 1999; 211(1): 3949.
  17. 17. 張精勇, 金星, 吳學(xué)君, 等. 濾器保護(hù)下置管溶栓治療下肢深靜脈血栓形成臨床總結(jié) [J]. 中國實(shí)用外科雜志, 2006; 26(10): 774776.
  18. 18. Comerota AJ, Throm RC, Mathias SD, et al. Catheterdirected thrombolysis for iliofemoral deep venous thrombosis improves healthrelated quality of life [J]. J Vasc Surg, 2000; 32(1): 130137.
  19. 19. Lin PH, 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.
  20. 20. Alesh I, Kayali F, Stein PD. Catheterdirected thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review [J]. Catheter Cardiovasc Interv, 2007; 70(1): 143148.
  21. 21. Kasirajan K, Milner R, Chaikof EL. Combination therapies for deep venous thrombosis [J]. Semin Vasc Surg, 2006; 19(2): 116121.
  22. 22. 黃曉鐘, 張紀(jì)蔚, 梁衛(wèi), 等. 介入腔內(nèi)溶栓治療急性下肢深靜脈血栓形成 [J]. 介入放射學(xué)雜志, 2006; 15(10): 592596.
  23. 23. 李國劍, 楊國凱, 何曉明, 等. 下腔靜脈濾器在治療下肢深靜脈血栓中的應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(11): 922924.
  24. 24. Greenfild LJ, Proctor MC. Recurrent thromboembolism in patients with vena cava filters [J]. J Vasc Surg, 2001; 33(3): 510514.