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经胫前静脉与经腘静脉入路行导管接触性溶栓治疗急性下肢深静脉血栓的疗效比较

Comparison of the efficacy of catheter-directed thrombolysis via anterior tibial vein and popliteal vein approaches in the treatment of acute lower extremity deep vein thrombosis

    摘要
  • 摘要:
    目的 比较经胫前静脉与经腘静脉穿刺入路行导管接触性溶栓（catheter-directed thrombolysis, CDT）治疗急性下肢深静脉血栓（deep vein thrombosis, DVT）的临床疗效、安全性及患者预后。
    方法 回顾性分析2020年1月至2023年12月于南通大学附属医院介入与血管外科确诊为急性混合型下肢DVT并接受CDT治疗的195例患者的临床资料，根据穿刺入路分为观察组（经胫前静脉入路，n＝97）与对照组（经腘静脉入路，n＝98）。比较两组患者的基线资料、溶栓相关指标（尿激酶用量、凝血功能指标）、疗效指标血栓溶解程度、腿围周径差、视觉模拟量表（visual analogue scale, VAS）评分、静脉临床严重程度评分（venous clinical severity score, VCSS）、康复指标（下床活动时间、住院时间）、并发症发生率及远期预后指标Villalta评分、血栓后综合征（post-thrombotic syndrome, PTS）发生率。
    结果 两组患者的尿激酶用量及凝血功能指标差异无统计学意义。观察组术后膝下15 cm腿围周径差、VAS评分及VCSS评分均显著低于对照组（P＝0.001）。观察组腘静脉及胫前静脉的Ⅲ级溶解率高于对照组（P＜0.05），而两组在髂静脉、股静脉中的血栓溶解率差异无统计学意义。观察组患者的住院时间短于对照组，下床活动时间早于对照组（P＝0.001）。两组患者并发症发生率、Villalta评分及PTS发生率差异无统计学意义。
    结论 经胫前静脉穿刺入路行CDT治疗急性混合型下肢DVT，在促进下肢肿胀消退、缓解疼痛、改善静脉临床症状及提高腘静脉、胫前静脉血栓溶解率方面优于经腘静脉入路，且患者恢复快，安全性良好。

     

    Abstract:
    Objective To compare the clinical efficacy, safety, and patient’ prognosis of catheter-directed thrombolysis (CDT) via anterior tibial vein and popliteal vein approaches in the treatment of acute lower extremity deep vein thrombosis (DVT).
    Methods A retrospective analysis was conducted on the clinical data of 195 patients diagnosed with acute mixed lower extremity DVT and treated with CDT in the Department of Interventional and Vascular Surgery, Affiliated Hospital of Nantong University from January 2020 to December 2023. Patients were divided into an observation group (anterior tibial vein approach, n＝97) and a control group (popliteal vein approach, n＝98) according to the puncture route. Baseline data, thrombolysis-related indices (urokinase dosage, coagulation function indices), efficacy measures (degree of thrombus dissolution, leg circumference difference, visual analogue scale VAS score, venous clinical severity score VCSS), recovery parameters (time to ambulation, length of hospital stay), complication rates, and long-term prognosis measures (Villalta score, incidence of post-thrombotic syndrome PTS) were compared between the two groups.
    Results There was no statistically significant difference in urokinase dosage and levels of coagulation function indices between the two groups. Postoperatively, the leg circumference difference at 15 cm below the knee, VAS score, and VCSS score were significantly lower in the observation group than in the control group (P＝0.001). The observation group had higher grade Ⅲ dissolution rates in the popliteal and anterior tibial veins compared to the control group (P＜0.05), while differences of dissolution rates in the iliac and femoral veins were not statistically significant. The observation group had shorter length of hospital stay and earlier ambulation times than the control group (P＝0.001). There were no significant differences in complication rates, Villalta scores, or PTS incidence between the two groups.
    Conclusions CDT via the anterior tibial vein puncture approach for acute mixed lower extremity DVT is superior to the popliteal vein approach in promoting resolution of lower extremity swelling, alleviating pain, improving venous clinical symptoms, and achieving higher thrombus dissolution rates in the popliteal and anterior tibial veins. It also enables faster recovery and demonstrates good safety.

     

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