[1]王 剑,钱 成,顾建平,等.两种非腘静脉入路置管溶栓治疗急性下肢深静脉血栓形成效果比较[J].介入放射学杂志,2025,34(07):714-720.[doi:10.3969/j.issn.1008-794X.2025.07.005]
 WANG Jian,QIAN Cheng*,GU Jianping*,et al.Catheter-directed thrombolysis via two types of non-popliteal venous access in the treatment of acute deep venous thrombosis of lower extremities:a comparative study[J].J Intervent Med,2025,34(07):714-720.[doi:10.3969/j.issn.1008-794X.2025.07.005]
点击复制

两种非腘静脉入路置管溶栓治疗急性下肢深静脉血栓形成效果比较()

PDF下载中关闭

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
34
期数:
2025年07
页码:
714-720
栏目:
血管介入
出版日期:
2025-07-25

文章信息/Info

Title:
Catheter-directed thrombolysis via two types of non-popliteal venous access in the treatment of acute deep venous thrombosis of lower extremities:a comparative study
文章编号:
1008-794X(2025)-007-0714-08
作者:
王 剑 钱 成 顾建平 高立兵 公茂峰 刘 亮 倪国庆 彭 鹏 陈国平
211100 江苏南京 南京医科大学附属江宁医院放射介入科(王 剑、高立兵、刘 亮、倪国庆、彭 鹏); 南京医科大学附属南京医院(南京市第一医院)介入血管科(钱 成、顾建平、公茂峰、陈国平)
Author(s):
WANG JianQIAN Cheng*GU Jianping*GAO LibingGONG Maofeng*LIU LiangNI GuoqingPENG PengCHEN Guoping*.
Department of Interventional Radiology,Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 211100,China; *Department of Vascular Intervention,Affiliated Nanjing Hospital of Nanjing Medical University(Nanjing Municipal First Hospital),Nanjing,Jiangsu Province 210006,China
关键词:
深静脉血栓形成 下肢 置管溶栓 胫静脉 股静脉 穿刺入路
分类号:
R543
DOI:
10.3969/j.issn.1008-794X.2025.07.005
文献标志码:
A
摘要:
目的 比较两种非腘静脉穿刺入路置管溶栓(catheter-directed thrombolysis,CDT)治疗急性混合型下肢深静脉血栓形成(deep vein thrombosis,DVT)的技术指标和临床效果。方法 回顾性收集2016年1月至2022年6月南京医科大学附属江宁医院和附属南京医院首选小腿深静脉入路(45例)和健肢股静脉入路(74例)行CDT治疗的急性下肢混合型DVT患者临床资料。评价比较两组间血管穿刺和置管技术成功率,以及成功置管的CDT静脉穿刺次数、置鞘时间、置管时间、溶栓时间、溶栓剂用量和相关并发症(包括静脉穿刺及抗凝溶栓相关并发症),不同解剖节段溶栓效果和至少随访12个月临床疗效。结果 选择小腿深静脉入路、健肢股静脉入路成功置管CDT患者分别为31例、58例,技术成功率分别为68.89%(31/45)、78.38%(58/74),差异无统计学意义(P=0.248)。小腿深静脉入路组21例(67.74%)置鞘成功需2针次以上穿刺; 健肢股静脉入路组置鞘时间明显少于小腿深静脉入路组[(1.84±0.87)min比(10.52±6.13)min,P<0.001],但置管时间明显长于小腿深静脉入路组[(41.60±13.31)min比(20.06±4.46)min,P<0.001]。健肢股静脉入路组、小腿深静脉入路组溶栓时间分别为(5.34±1.43)d、(5.06±1.18)d(P=0.354),但健肢股静脉入路组溶栓剂用量较多[(352.16±71.98)万U比(284.68±77.64)万U,P<0.001]。末次随访显示,小腿深静脉入路组股腘静脉通畅率程度明显高于健肢股静脉入路组(P=0.037)。两组间血栓形成后综合征(post-thrombotic syndrome,PTS)发生率、静脉功能不全流行病学和经济研究-生活质量/症状(VEINES-QOL/Sym)问卷调查评分比较差异无统计学意义(均P>0.05)。结论 小腿深静脉入路CDT与健肢股静脉入路CDT相比,可更好地清除腘静脉和股浅静脉内血栓,提高股腘静脉通畅率,但在减少PTS发生和改善患者VEINES-QOL/Sym上并无明显优势,且对小腿深静脉穿刺置鞘技术要求更高。

参考文献/References:

[1] 中国医师协会介入医师分会,中华医学会放射学分会介入专业委员会,中国静脉介入联盟.下肢深静脉血栓形成介入治疗规范的专家共识(第2版)[J].介入放射学杂志,2019,28:1-10.
[2]Vedantham S,Desai KR,Weinberg I,et al.Society of Interventional Radiology Position Statement on the Endovascular Management of Acute Iliofemoral Deep Vein Thrombosis[J].J Vasc Interv Radiol,2023,34:284.e7-299.e7.
[3]Haig Y,Enden T,Grøtta O,et al.Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5-year follow-up results of an open-label,randomised controlled trial[J].Lancet Haematol,2016,3:e64-71.
[4]Comerota AJ,Kearon C,Gu CS,et al.Endovascular thrombus removal for acute iliofemoral deep vein thrombosis[J].Circulation,2019,139:1162-1173.
[5]Notten P,Ten Cate-Hoek AJ.Catheter interventions:an unresolved clinical controversy:authors' reply[J].Lancet Haematol,2020,7:e190.
[6]陈国平,顾建平,何 旭,等.双向联合溶栓治疗急性混合型下肢深静脉血栓形成的临床疗效[J].临床放射学杂志,2014,33:421-425.
[7]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,1999,211:39-49.
[8]Vedantham S,Grassi CJ,Ferral H,et al.Reporting standards for endovascular treatment of lower extremity deep vein thrombosis[J].J Vasc Interv Radiol,2006,17:417-434.
[9]Kahn SR,Partsch H,Vedantham S,et al.Definition of post-thrombotic syndrome of the leg for use in clinical investigations:a recommendation for standardization[J].J Thromb Haemost,2009,7:879-883.
[10]Huang T,Ding W,Chen Z,et al.Comparison of pharmacomechanical catheter-directed thrombolysis versus catheter-directed thrombolysis for the treatment of acute iliofemoral deep vein thrombosis:measures of long-term clinical outcome and quality of life[J].Ann Vasc Surg,2021,76:436-442.
[11]Chen G,Wang Q,Chen Y,et al.The short-term outcome of residual thrombus of the lower extremity after pharmacomechanical catheter-directed thrombolysis for deep vein thrombosis[J].Ann Transl Med,2020,8:1001.
[12]Kearon C,Gu CS,Julian JA,et al.Pharmacomechanical catheter-directed thrombolysis in acute femoral-popliteal deep vein thrombosis:analysis from a stratified randomized Trial[J].Thromb Haemost,2019,119:633-644.
[13]Wang H,Qi X,Luo H,et al.Catheter-directed thrombolysis through anterior tibial vein for treating acute extensive deep venous thrombosis[J].J Vasc Surg Venous Lymphat Disord,2018,6:681-688.
[14]郝苏荣,陈国平,顾建平,等.经小腿深静脉途径导管溶栓术治疗急性混合型下肢深静脉血栓形成[J].临床放射学杂志,2020,39:969-973.
[15]Wang H,Qi X,Chen Y,et al.A Retrospective study comparing 2 approaches to catheter-directed thrombolysis for acute deep venous thrombosis[J].Ann Vasc Surg,2018,50:30-37.
[16]渠艳艳,卫志庆,石红建,等.股静脉及胫前静脉入路导管接触溶栓治疗急性下肢深静脉血栓形成患者近期效果和安全性观察[J].介入放射学杂志,2024,33:774-779.
[17]Qian C,Chen GP,Lou WS,et al.The perplexity of catheter-directed thrombolysis for deep venous thrombosis:the approaches play an important role[J].J Thromb Thrombolysis,2021,51:757-766.
[18]Ni Q,Long J,Guo X,et al.Clinical efficacy of one-stage thrombus removal via contralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis[J].J Vasc Surg Venous Lymphat Disord,2021,9:1128-1135.
(收稿日期:2024-10-29)
(本文编辑:谷 珂)

相似文献/References:

[1]顾建平,范春瑛,何旭,等.下肢深静脉血栓形成的综合性介入治疗[J].介入放射学杂志,2000,(04):206.
[2]肖亮,徐克,申景,等.Gunther Tulip可回收式腔静脉滤器在急性下肢深静脉血栓形成介入治疗中的作用[J].介入放射学杂志,2010,(09):707.
 XIAO Liang,XU Ke,SHEN Jing,et al.The application of Günther Tulip retrievable inferior vena cava filter in interventional treatment for acute deep venous thrombosis of lower extremity[J].J Intervent Med,2010,(07):707.
[3]沈国鑫,皇玉琴.下肢动脉的二氧化碳DSA造影[J].介入放射学杂志,1997,(04):213.
[4]常占平,王洪芬.影像学浅静脉穿刺的体会[J].介入放射学杂志,1998,(01):64.
[5]杨永岩,林茂,吴纪瑞,等.髂股动脉栓塞的造影诊断[J].介入放射学杂志,1995,(03):165.
[6]吴贵华.下肢骨肉瘤的介入治疗(附12例报告)[J].介入放射学杂志,1995,(03):168.
[7]罗兴梅.经皮穿刺腰椎间盘切除术的护理[J].介入放射学杂志,1996,(01):52.
[8]夏彩凤,顾建平,楼文胜,等. 急性下肢动脉栓塞与血栓形成的临床异同分析[J].介入放射学杂志,2012,(05):369.
 ,,et al. Clinical factors useful for the differentiation of acute arterial embolism from acute arterial thrombosis of the lower extremities[J].J Intervent Med,2012,(07):369.
[9]蒋忠铭,徐清华.经小隐静脉置管溶栓治疗下肢深静脉血栓形成[J].介入放射学杂志,2010,(12):944.
 JIANG Zhong-ming,XU Qing-hua..Transcatheter thrombolysis via the small saphenous vein for deep venous thrombosis of lower limb[J].J Intervent Med,2010,(07):944.
[10]张玲玲,朱悦琦,牟 凌.糖尿病下肢血管病变球囊成形术后高灌注并发症的观察与护理[J].介入放射学杂志,2011,(03):237.
 ZHANG Ling-ling,ZHU Yue-qi,MO Lin.Observation and nursing of complications due to high re-perfusion injury occurring after balloon angioplasty for diabetic vascular diseases of lower extremity[J].J Intervent Med,2011,(07):237.

备注/Memo

备注/Memo:
通信作者: 陈国平 E-mail:chenguoping_72@163.com
更新日期/Last Update: 2025-07-25