左下肢深静脉血栓介入治疗中左侧股静脉入路的临床应用.docVIP

精品论文 参考文献 左下肢深静脉血栓介入治疗中左侧股静脉入路的临床应用 王秀平 刘建 张岩 李晨 王彬 姚忠强 [摘 要] 目的 探讨左下肢深静脉血栓（deep venous thrombosis,DVT）介入治疗中采用左侧股静脉入路的方法及其临床应用的可行性。方法 从2004年3月～2012年4月间，采用经右侧股静脉或颈静脉等常用入路方法（简称入路1)对185例左下肢DVT患者进行导管溶栓（catheter directed thrombolysis,CDT）治疗，对置管失败的35例患者，尝试采用左侧股静脉顺行性穿刺入路（简称入路2)，29例建立起左-右侧股静脉间或左股静脉-右颈静脉间的导丝轨道，其中17例直接沿导丝轨道自右向左逆行置入导管，9例同时使用“翻山血管鞘”辅助置管，3例合并髂静脉压迫综合症（即Cockett综合征）者，先经入路2插入球囊导管对左髂静脉狭窄处进行预扩张，再沿导丝轨道进行置管。对所得的数据采用 检验。结果 185例左下肢DVT患者采用入路1插管成功150例，失败35例，置管成功率为81.1%（150/185）；对置管失败的35例患者，采用入路2后31例置管重新获得成功，4例失败，置管成功率为88.6%（31/35）；入路1辅以入路2后，左下肢DVT介入治疗总的置管成功率达到97.8%（181/185），同单纯采用入路1比较，统计学有显著性差异（ =27.54， P＜0.001 )。经过3～14天的CDT治疗，血栓完全或大部分被溶解;左侧股静脉穿刺处未发生明显淤血和血肿，也无其它严重并发症发生。结论 在左下肢DVT介入治疗中，对从右侧股静脉或右侧颈静脉入路困难或失败者，采用左侧股静脉顺行穿刺入路可以作为有效的补充方法，技术成功率高、安全、创伤小，临床应用可行。 [关键词]左下肢 深静脉血栓 左侧股静脉 入路 介入治疗 Clinical Application of the Left Femoral Vein Approach during the Interventional Therapy for Deep Vein Thrombosis of Left Lower Extremity Wang Xiuping, Liu Jian, Zhang Yan, Li Chen, Wang Bin, Yao Zhongqiang Abstract: Objective To investigate the method and clinical feasibility of the left femoral vein approach during interventional therapy for left lower extremity deep vein thrombosis (DVT). Methods From March 2004 to April 2012, routine approaches as the right femoral vein or jugular vein approach (approach 1) were used during catheter-directed thrombolysis (CDT) for the treatment of 185 cases with left lower extremity DVT. For the 35 cases with failed catheter intubations, the left femoral vein antegrade puncture approach (approach 2) was tried. The guide wire track between the left-right femoral veins or the left femoral vein-right Jugular vein was established in 29 cases. Among these 29 cases, retrograde intubations from right to left directly along the guide wire track was performed in 17 cases; “crosses sheath” technique was used at the same time for assistant intubations in 9 cases. For the 3 cases with iliac vein compression syndrome (or Cockett syndrome),