静脉顺行性溶栓治疗急性混合型下肢深静脉血栓形 .docVIP

急性混合型的溶栓治疗【摘要】　目的　探讨逆行置管溶栓联合经患肢足背浅静脉顺行性溶栓治疗急性混合型下肢深静脉血栓形成的临床疗效。方法　27例急性混合型患者逆行置管溶栓联合患肢足背浅静脉顺行性溶栓对其溶栓效果和临床疗效进行回顾性分析。结果　经健侧股静脉和经右侧颈内静脉逆行置管的患者分别为23和4例联合溶栓时间~10）d，平均7.92±1.24）d。27例髂总静脉、髂外静脉、股总静脉、股浅静脉、腘静脉及小腿深静脉段的±28.32%，81.11±25.58%，82.96±23.17%，62.41±25.62%，69.44±26.43%和47.04±19.48%。22例患者髂静脉存在不规则狭窄或闭塞，行PTA和支架植入。出院时髂股静脉完全再通部分再通闭塞19例（7%），例（%）例（%）。临床疗效有效无效例（%）例（）2例（）溶栓期间没有症状性和大出血的发生发生小的出血并发症3例（%）平均随访±4.85个月，髂股静脉完全再通部分再通闭塞的患者行走时患肢出现肿胀沉重感，。6个月时静脉造影复查显示髂静脉支架通畅率为%（20/22）。12个月时14例患者彩色多普勒超声检查显示3例（21.43%）开通的股静脉瓣膜功能有反流征象。结论　混合型逆行置管溶栓快速清除患肢近端血栓，髂股静脉主干，联合患肢足背浅静脉顺行性溶栓使侧支开放，降低静脉压，缓解症状。 【关键词】 深静脉血栓形成，下肢溶栓术治疗，溶栓 Thrombolysis therapy for acute mixed lower extremity deep venous thrombosis 【Abstract】 Objective To investigate the clinical efficacy of retrograde catheter directed thrombolysis combined with trans-dorsalis pedis vein anterograde thrombolysis therapy for acute mixed lower extremity deep venous thrombosis (LEDVT). Methods 27 patients of acute mixed LEDVT were treated with the retrograde catheter directed thrombolysis together with trans-dorsalis pedis vein anterograde thrombolysis, The thrombolytic effect and clinical curative effect were analyzed retrospectively. Results The retrograde catheter directed thrombolysis were performed via the contralateral femoral vein and the right internal jugular access in 23 and 4 patients respectively. The combination thrombolysis therapy time was 5~10days, with an average of (7.92±1.24 ) days. The clot lysis rates of iliac vein, external iliac vein, femoral vein, superficial femoral vein, popliteal vein and calf deep vein segments were 54.07±28.32%, 81.11±25.58%, 82.96±23.17%, 62.41±25.62%, 69.44±26.43% and 47.04±19.48% respectively in 27 patients. The PTA and stent implantation were performed in 22 patients with iliac vein irregular stenosis or occlusion. The iliofemoral vein completely recanalization, partly recanalization and occlusion were 19 cases (70.37 %), 4 cases (14.81% ) and 4 cases (14.81%) respectively in the discharge from hos