目的研究置管溶栓联合球囊扩张导管碎栓治疗下肢深静脉血栓形成（DVT）的疗效及安全性。 方法回顾性分析2011年9月至2015年1月本院收治的82例急性下肢DVT患者的临床资料。将患者分成两组：A组行单纯经导管直接溶栓（CDT）治疗，共32例，其中男10例、女22例，平均年龄（56±15）岁；B组行CDT联合机械碎栓（球囊扩张导管碎栓）治疗，共50例，其中男18例、女32例，平均年龄（57±17）岁。比较2组治疗前后静脉通畅率、静脉通畅度评分、健侧和患侧下肢周径差，比较2组尿激酶用量及溶栓导管留置时间，以出血并发症、肺栓塞的发生率评价治疗的安全性。 结果2组共82例患者完成溶栓及碎栓疗程，B组较A组溶栓时间更短，A组平均9（7，12）d；B组平均5（4，7）d，2组差异有统计学意义（P<0.01）；B组较A组尿激酶用量更少，A组平均7.250（6.355，8.255）×106 U，B组平均4.925（3.715，5.810）×106 U，2组差异有统计学意义（P<0.01）；B组治疗后的静脉通畅度评分显著优于A组，A组65.0%（40.5%，86.5%），B组为100%（90%，100%），差异有统计学意义（P<0.01）。治疗后2组出血并发症发生率差异无统计学意义（P=0.0976）。2组患者随访时间3～18个月，A组随访率50.0%，B组随访率58.0%，均未发生肺动脉栓塞。 结论在下腔静脉滤器保护下，CDT联合球囊扩张导管碎栓治疗急性下肢DVT较单纯CDT治疗，溶栓效果好、尿激酶用量少、不增加肺栓塞及出血发生率。
Objective To report the screening, prevention and treatment of venous thrombosis for Lushan earthquake victims in the West China Hospital of Sichuan University. Methods Among the Lushan earthquake victims screened by vascular color Doppler, those with detected venous thrombosis were treated reasonably, and those without detected venous thrombosis were prevented early. Results There were total 235 Lushan earthquake victims in the hospital as of the 11th day after earthquake, and they were screened by vascular color Doppler. Among 26 cases with detected venous thrombosis, 25 were lower limb venous thrombosis, and the other one was upper limb venous thrombosis. Three cases were treated by rehabilitation intervention alone, three cases were treated by drug intervention alone, and the other 20 cases were treated by both rehabilitation and drug intervention. As of 30 days after the earthquake, the reexamination results of 26 victims with venous thrombosis showed that: 11 cases improved, including 5 completely recanalization and 6 incompletely recanalization. Among the three cases with drug intervention alone, one got completely recanalization, accounted for 33.33%. Among the three cases with rehabilitation intervention alone, one got incompletely recanalization, accounted for 33.33%. Among the 20 cases with both rehabilitation and drug intervention, four got completely recanalization, accounted for 20.0%, and five got incompletely recanalization, accounted for 25.0%. Conclusion Most Lushan earthquake victims with venous thrombosis are the elderly and women, stay in the ICU, and suffer from fractures in different degrees. The timely prevention and treatment can relieve local pain, promote early entry in the rehabilitation treatment, and prevent pulmonary embolism and other risks. The rehabilitation intervention and/or drug intervention should be adopted to the victims with detected venous thrombosis as well as the victims without detected venous thrombosis but have high risk factors, for it can effectively prevent and treat the further thrombosis and other bad consequences of the detachment of thrombus.
ObjectiveTo investigate the risk factors,characteristics and prognosis in Tibetan patients with venous thromboembolism. MethodsTibetan patients with VTE from plateau area,admitted in West China Hospital from January 2010 to December 2012,were recruited in the study. The VTE diagnosis was confirmed by CT pulmonary angiogram (CTPA) or vascular ultrasound examination. Risk factors,clinical symptoms,signs and laboratory tests were retrospectively investigated and follow-up by telephone interview was conducted. Results31 Tibetan VTE patients with 16 males and 15 females were included. The investigation of risk factors revealed that 15 patients suffered from obese(48.3%),10 patients suffered from highly viscous hyperlipidemia(32.3%). The most common clinical symptom was dyspnea(29%),followed by chest pain(19.4%),hemoptysis(16.1%) and cough(12.9%). The common signs were lower extremity edema(73.3%) and lung rale(36.7%). All the patients received anticoagulation therapy,and inferior vena caval filters were implanted in 2 patients. In two years' follow-up after discharge,2 patients died of tumor,2 died of pulmonary embolism,6 patients suffered from chronic embolization syndrome with lower extremity edema or pain,1 patient suffered from pulmonary hypertension after embolization,and thrombus in 20 patients disappeared or recanalized. ConclusionTibetans long-termly reside in high altitude areas with the eating habits of high-fat diet,which may increase the incidence of acquired risk factors such as viscous hyperlipidemia and obesity. There are no specific clinical symptoms and signs among Tibetan VTE patients,with dyspnea as the most common symptom and lower extremity edema as the most common sign. Patients with risk factors which can be eliminated in a short term have better prognosis.
目的:评价综合康复措施对预防地震髋部骨折伤员深静脉血栓形成的作用。方法：按深静脉血栓形成的高危因素对195例地震髋部骨折伤员进行分级评估,并针对性实施综合康复措施,观察深静脉血栓的症状和体征,了解深静脉血栓的发生情况。结果：地震髋部骨折伤员应用综合康复措施后,尚未发现下肢深静脉血栓形成的病例。结论：综合康复措施能有效地预防地震髋部骨折伤员深静脉血栓的形成。
Objective To explore the effect of endovascular treatment guided by ultrasonography combined with portosystemic shunts on the patients with Budd-Chiari Syndrome （BCS）.Methods The clinical data of 136 patients with BCS treated by balloon angioplasty and stent implantation guided by Doppler ultrasonography in our hospital from January 1995 to January 2011 were retrospectively analyzed.After balloon angioplasty,53 patients were treated by inferior vena cava （IVC） stent implantation and 31 patients with hepatic venous occlusion underwent portosystemic shunts （PSSs） at one week after endovascular treatment.The long-and short-term effects after treatment were studied.Results After endovascular procedures,the IVC pressure of patients significantly decreased （P＜0.01）,while IVC diameter, flow velocity in the lesion,and right atrial pressure of patients showed significant increase（P＜0.01）.Slight heart dysfunction appeared in 13 cases of patients.After shunting,acute pancreatitis occurred in 3 cases, and 1 patient died of upper gastrointestinal hemorrhage on the 10 d after PSSs.Doppler ultrasonography for IVC and shunt vessels showed：the swollen liver and spleen lessened on 3d after endovascular procedures.The swollen liver lessened 2-7cm （mean 5.5cm）,swollen spleen lessened 3-8cm （mean 5.8cm）, and the time of ascites disappearance was 3-60d （mean 14d）.All the patients were followed up for 1 month to 15 years with an average of 3 years.Restenosis of the distal part of stent was found in 1 patient in 2 years after operation, hepatic vein occlusion occurred in 1 case in 1 year after treatment,hepatocellular carcinoma occurred in 1 patient in 3 years after stent implantation,and 1 patient died of C type hepatitis after 1 year,and 5 out of 6 cases of patients with infertility had babies after 1 year.All patients had no stent migration or occlusion of shunts and the symptoms of portal hypertension were obviously relieved.Conclusions Endovascular treatment guided by Doppler ultrasonography is a convenient,safe,and effective method for BCS.Portosystemic shunts are commended to patients with hepatic venous occlusions.The above mentioned methods provide a feasible and effective means for IVC stenosis and short segment occlusion with hepatic vein occlusion of BCS.
ObjectiveTo evaluate the treatment effective of deep vein thrombosis (DVT) of low extremities. MethodsThe clinical data of 86 patients with DVT were analyzed retrospectively, which were divided into thromboectomy group (12 patients) and thrombolysis group (74 patients) according to the therapy methods. The thromboectomy group patients were treated by thromboectomy using Fogarty balloon catheter plus thrombolytie, thrombolysis group patients were treated by thrombolysis (urokinase or antithrombus enzyme of viper). ResultsThere were 8 cases healed, 4 cases relieved, 0 invalidated in the thromboectomy group and 15 cases healed, 50 cases relieved, 9 cases invalidated in the thrombolysis group at discharge. During 3-100 months of following up with an average 27 months, 10 cases and 62 cases were examined by Bultrasonic in the thromboectomy group and thrombolysis group, respectively, 6 cases were not damaged in the function of valves of the thromboectomy group, 9 cases were not damaged in the function of valves of the thrombolysis group. The rates of acute response, longtime patency, and normal valve in the thromboectomy group were higher than those in the thrombolysis group (Plt;0.05), the rate of post-thrombotic syndrome in the thromboectomy group was lower than that in the thrombolysis group (Plt;0.05). ConclusionsEarly thromboectomy is an effective way of restoring the fluency of deep vein and protecting the efficiency of the vein value organization, and reducing the sequela of DVT. Thrombolysis can only relieve the symptomation, but it can not protect the crawling and relapsing of thrombus.
ObjectiveTo explore the value of potaried technique with Trivex system in treatment for venous skin ulcer with deep venous thrombosis sequelae (DVTS) of lower limbs. MethodsTotal 166 patients with venous skin ulcer with DVTS of lower limbs were included in this study. The patients of operation group (94 patients involving 94 legs) were treated by using potaried technique with Trivex system. The patients of nonoperation group (72 patients involving 72 legs) were treated by using nonoperative method. The clinical indexes of skin infection rate, skin necrosis rate, shrinkage rate of wound area, skin depigmentation rate, ulcer healing rate and ulcer recurrence rate were used to assess the clinical curative effect between two groups on 5, 20, 120 and 360 d after operation or treatment, respectively. ResultsThere were no skin infection and skin necrosis in two groups on 5 d after operation or treatment. The rate of shrinkage of wound area and skin depigmentation of patients in operation group were significantly higher than those in nonoperation group on 20 d after operation or treatment 〔(95.8±2.138)% vs. (68.7±3.125)%，P=0.048; (87.6±1.263)% vs. (12.3±1.324)%， P=0.018〕. The rate of the ulcer healing of patients in operation group was significantly higher than that in nonoperation group on 120 d after operation or treatment (97.9%vs. 8.3%， P=0.014). The rate of the ulcer recurrence of patients in operation group was significantly lower than that in nonoperation group on 360 d after operation or treatment (5.3% vs. 97.2%， P=0.015). ConclusionThe potaried technique with Trivex system can be used as one of the surgical treatment methods for venous skin ulcer with DVTS of lower limbs.
目的 总结我科2002年3月至2005年10月收治的下肢深静脉血栓形成(deep vein thrombosis,DVT)患者的诊治经验.方法 本组下肢DVT患者275例,患肢294条.男134例,女141例,年龄14～92岁,平均(50.76±16.43)岁.单侧下肢DVT 256例(左侧159例,右侧97例),19例为双下肢DVT(其中有8例是仅一侧肢体有临床表现); 属混合型194条,中央型74条,周围型26条.行彩色多普勒或静脉造影检查了解血栓部位及范围; 对怀疑有肺动脉栓塞(pulmonary embolism, PE)者行肺部增强CT扫描.治疗包括抗凝、溶栓、祛聚、梯度压力静脉弹力袜以及对症处理.对反复发生PE、存在抗凝治疗禁忌证、需要手术取栓、下肢静脉存在悬浮游离血栓者安置下腔静脉滤器.对发生股青肿患者行手术取栓.疗效评价: 住院期间观察症状变化,监测膝关节上、下15 cm处周径; 对随访患者行CEAP(clinical-etiology-anatomic-pathophysiologic)临床表现分级、功能障碍评分(venous disability score, VDS).结果 本组DVT常见的危险因素包括活动受限史、2周以内有手术史、恶性肿瘤及外伤史.本组患肢主要临床表现包括: 肿胀、疼痛、皮温增高、皮肤暗红、浅静脉迂曲等.并发症: PE 9例,股青肿2例,下腔静脉阻塞综合征3例.275例中2例行手术取栓,25例安置下腔静脉滤器.本组患者症状经治疗后1～5 d开始缓解,出院时膝关节上、下周径较入院时明显缩小(P＜0.05).随访时间6个月～3年,195例(70.9%)的201条(68.4%)患肢获得随访,患肢CEAP分级: C0级78条,C1级53条,C2级16条,C3级20条,C4级15条,C5级11条,C6级8条; VDS评分: 0分77例,1分66例,2分33例,3分19例.结论 下肢DVT的诊断中应注意对危险因素以及无症状的DVT的搜寻; 早期治疗以非手术治疗为主,通过抗凝、溶栓等综合治疗可以达到满意效果; 在早期如发生股青肿应及时手术治疗; 有选择地安置下腔静脉滤器可防止PE的发生; 后期应根据病情特点确定治疗方案和疗程.