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。
目的探讨经腘静脉置溶栓导管灌注溶栓治疗急性下肢深静脉血栓形成（DVT）的临床应用价值。方法对28例急性DVT患者（其中2例合并肺动脉栓塞）在超声引导下经患肢腘静脉穿刺置入溶栓导管至髂、股静脉血栓中进行溶栓治疗，并对溶栓效果进行分析。 结果全组患者溶栓后症状明显改善，下肢肿胀消退，肺部症状缓解。溶栓后患、健侧大腿周径差〔(1.72±1.23) cm〕明显小于溶栓前〔(5.47±1.29) cm〕,差异有统计学意义(t=12.14，Plt;0.01)， 患肢大腿消肿率为91.58%; 溶栓后患、健侧小腿周径差〔(1.55±0.77) cm〕也明显小于溶栓前〔(5.04±1.32) cm〕，差异有统计学意义（t=13.81，Plt;0.01)，患肢小腿消肿率为84.92%。溶栓后静脉通畅评分〔(4.34±3.55)分〕明显低于溶栓前〔(15.23±4.64) 分〕，差异有统计学意义(t=6.42，Plt;0.01 )，溶栓后静脉平均通畅率为87.43%。 2例合并肺动脉栓塞患者中，1例栓子完全溶解，1例大部分溶解。 所有患者均无严重并发症。 25例患者获随访，随访1～12个月（平均7.16个月），无一例出现血栓再发。结论经腘静脉置管溶栓治疗急性DVT是一种安全、有效的治疗方法。
ObjectiveTo evaluate the value of clinical application of determination of lower venous pressure in the diagnosis and treatment of deep venous thrombosis (DVT). MethodsThe 90 patients with DVT of unilateral lower limb who were admitted by using color Doppler or deep veins of lower limb angiography in our hospital during the period of 2013 July to 2014 June were selected and as the research object (case group), 37 cases were male, 53 cases were female; the age was 18-84 years old, mean age was 59.48 years old. According to the development of disease, 90 cases were divided into acute 30 cases, subacute 30 cases, and chronic 30 cases; and according to the pathological types were divided into the central type in 30 cases, 30 cases of peripheral type, and 30 cases of mixed type. At the same time the without lower extremity DVT volunteers of 20 cases were selected as normal control group, including male 9 cases, female 11 cases; age was 21-65 years old, average age was 38.7 years old. The static venous pressure (P0), dynamic venous pressure (P00), and decreased pressure ratio (Pd) of double lower limbs of participants in 2 groups were determinated and comparative analyzed. ResultsThe P0 and P00 of patients with different development of disease and pathological types of the case group were higher than those of the normal control group (P < 0.01), and the Pd was lower than that of the normal control group (P < 0.01). In case group, the P0 and P00 of acute phase were higher than those of the normal control group (P < 0.01), the P0 of central type was higher than that of the peripheral type and mixed type (P < 0.01), and the Pd central type was lower than that of mixed type (P < 0.01). The above 3 indexes' differences of double lower limbs in the normal control group had no statistical significance (P > 0.01). In case group, the P0 and P00 of ipsilateral limb in different development of disease and pathological types were higher than those of the healthy limb, and the Pd were lower than that of the healthy limb (P < 0.01). ConclusionsLower extremity venous pressure measurements can be used in clinical detection for early lower limb DVT, and can be used as the objective index of clinical evaluation curative effect for the treatment of DVT. It is a simple and practical clinical detection method.
ObjectiveTo compare the differences of incidence rate and severity of postthrombotic syndrome (PTS) of patients with lower extremity deep venous thrombosis (DVT) treated by catherter-directed thrombolysis (CDT) or via peripheral vein thrombolysis (PVT).MethodsThe patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected. These patients were divided into CDT group and PVT group according to the different thrombolysis methods, and then the thrombolytic rates, thrombolytic complications, and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.ResultsA total of 137 cases of DVT were collected, 79 in the CDT group and 58 in the PVT group. There were no significant differences in the gender, age, course of disease, thrombus type, and other baseline data between the two groups (P>0.05). The thrombolytic rate of the CDT group was (78.6±16.3)% and PVT group was (27.3±12.1)%, the difference was significant (t=21.14, P<0.001). The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance (32.8% versus 21.5%, χ2=2.18, P=0.134). The 5-year follow up was completed in 116 cases, 74 patients from the CDT group and 42 patients from the PVT group respectively, the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group (35.1% versus 88.1%, χ2=30.28, P<0.001), and theseverity of PTS in the CDT group was milder than that in the PVT group too (Z=16.52,P<0.001).ConclusionFrom the results of this study, CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.
ObjectiveTo summarize the new biomarkers of deep venous thrombosis (DVT) and their research progress, so as to provide new ideas for the prevention, diagnosis and treatment of DVT. MethodThe literature about biomarkers of DVT in recent 5 years was reviewed and summarized. ResultsAccording to the results of literature review, a variety of common DVT biomarkers such as serum microrna, fibrin monomer, neutrophil capture net, and E-selectin were sorted out, but most of them had not been used in clinical DVT management. At present, the clinical diagnosis of DVT required the combination of positive D-dimer test and positive imaging examination, and there was no single biomarker for the diagnosis of DVT. ConclusionsBiomarkers are valuable in the diagnosis and treatment of DVT, but their sensitivity and specificity need to be optimized. Therefore, finding biomarkers with more diagnostic value is one of the future directions. At the same time, we also can consider fully combined with a variety of existing biomarkers, to improve the efficiency to the diagnosis of DVT.
摘要:目的: 探讨动脉硬化闭塞症(ASO)和静脉血栓形成(VT)患者同型半胱氨酸(Hcy)变化。 方法 :通过循环酶法对34例非动脉硬化闭塞症(ASO)和静脉血栓形成(VT)患者(对照组),30例动脉硬化闭塞症(ASO)患者和26例静脉血栓形成(VT)患者血液中Hcy进行测定。 结果 :循环酶法测定HCY的批内平均变异系数为2．23％,批间平均变异系数为1．59％。34例对照组,〖WTBX〗t =1135,〖WTBX〗P =0266gt;005;动脉硬化闭塞症(ASO)组Hcy含量明显高于对照组(〖WTBX〗P lt;O．05),静脉血栓形成(VT)组Hcy含量高于对照组(〖WTBX〗P lt;0．O5)。 结论 :高同型半胱氨酸血症可能是动脉硬化闭塞症(ASO)和静脉血栓形成(VT)及复发的致病因素。可将同型半胱氨酸作为动脉硬化闭塞症(ASO)和静脉血栓形成(VT)及复发的重要指标。Abstract: Objective: TO syudy the changes of the Homocysteine about Atherosclerosis obliterans and Venous thrombosis patients. Methods : To measure the Hcy in the blood of 34 healthy cases both non ASO and non VT(the comparison group),30 cases of ASO patients and 26 cases of VT patients respectively by enzymatic cycling assay。〖WTHZ〗Results :The average variation coefficient of Hcy within the groups was 223% and among the groups was 159% measured by enzymatic cycling assay.In the 34 cases of comparison group,t=1135,P=0266gt;005,The content of Hcy in the blood of ASO patients group were significantly higher than the comparision group (Plt;005),and the content of Hcy in the blood of VT patients group were also higher than the comparison group (Plt;005). Conclusion : Hyper Hcy may be the pathogenic diathesis to form or to recrudesce ASO and VT.So we can treat Hcy as the significant index to form or to recrudesce ASO and VT.
ObjectiveTo summarize the experience of treating lower extremity deep venous thrombosis (DVT) after repair of inguinal hernia. MethodThe clinical data of 1 812 patients who underwent herniorrhaphy from January 2002 to December 2012 were reviewed, and we analyzed such data as age, gender, and the formation of DVT. ResultsFive of them suffered from DVT (0.28%), including 2 cases involving both lower extremities, 1 right and 2 left extremity. All of them were discharged from hospital by anticoagulant therapy and there was no pulmonary embolism and death case. DVT recovered well in 4 cases half a year after being discharged from the hospital. One had a sequela of recurrent swelling of the left lower extremity. ConclusionsReasonable precautions and treatment against DVT are very important even though DVT rate after inguinal hernia repair is low.
Venous thromboembolism (VTE), comprising both deep vein thrombosis and pulmonary embolism, is a chronic illness that contributes significantly to the global burden of disease. The American College of Chest Physicians (ACCP) published the 9th edition of antithrombotic treatment guidelines for VTE (AT9) in 2012, which was first updated in 2016. In October 2021, ACCP published the 2nd update to AT9, which addressed 17 clinical questions related to VTE and presented 29 guidance statements in total. In this paper we interpreted the recommendations proposed in this update of the guidelines.
ObjectiveTo summarize diagnostic strategies of unilateral lower limb swelling. MethodThe clinical data of 357 patients hospitalized with unilateral lower limb swelling from March 2013 to October 2014 in our department were analyzed retrospectively. ResultsThree hundred and seven (86.0%) patients were admitted to hospital within 2 weeks since the symptom onset (acute swelling), the most common cause (281 cases) was lower extremity deep vein thrombosis (DVT), other causes included infection (11 cases), hematoma (7 cases), lymphatic obstruction (4 cases), iliac vein compression syndrome (2 cases), pelvic tumor compression (1 case), arteriovenous fistula (1 case). Etiology for chronic swelling contained lower extremity DVT (33 cases), arteriovenous fistula (5 cases), lymphatic obstruction (5 cases), Klippel-Trenaunay syndrome (3 cases), pelvic tumor compression (3 cases), iliac vein compression syndrome (1 case). Up to 60.5% (26/43) lower limb swelling which were not due to DVT had histories of misdiagnosis as DVT. Nine cases of lymphatic obstruction were secondary to malignant tumor itself or the sequel of treatment. Three hundred and thirty-eight (94.6%) patients were received lower limb doppler ultrasound, while 308 patients (91.9%) were diagnosed. Fifty-nine patients needed further CT venography (CTV) or CT angiography (CTA), 10 patients were received radionuclide lymphoscintigraphy to be diagnosed. ConclusionsAlthough DVT is the main cause of unilateral lower limb swelling, the lower limb swelling which is not due to DVT is frequently misdiagnosed and belatedly treated. Considering the complexity and reciprocal overlapping for the etiology of lower limbs swelling, developing a appropriate diagnosis strategy is important. Apart from history taking and physical examination, color doppler ultrasound for the lower limb is suggested to be the preferred imaging examination mean. Pelvic cavity screening for occupancy lesions and iliac vein should be evaluated synchronously if possible. For cases which can't be diagnosed by ultrasound, CTV, CTA, or radionuclide lymphoscintigraphy could be important supplement to assist the diagnosis.