目的 探讨经大隐静脉-穿通支静脉入路行深静脉置管溶栓术(catheter-directed thrombolysis，CDT)治疗混合型下肢深静脉血栓形成(deep venous thrombosis，DVT）的临床疗效。 方法 对42例急性混合型下肢DVT患者，经踝大隐静脉-穿通支静脉入路，将溶栓导管置入深静脉行CDT治疗。回顾性分析该42例患者的临床资料，评价其溶栓疗效。 结果 42例患者均成功经大隐静脉-穿通支静脉入路行CDT治疗。溶栓时间为5～7 d、(4.22±1.43) d；术后所有患者的肢体肿胀均明显好转；大腿周径差由术前的（7.76±1.72）cm缩减为术后的（2.21±0.91) cm（t=14.18，P＜0.01），小腿周径差由术前的（4.45±1.33）cm缩减为术后的(1.43±0.69）cm（t=11.92，P＜0.01），静脉通畅度评分由术前的12分降为术后的3分（Z=-3.03，P＜0.01）。术后发生穿刺处渗血2例，血尿2例，少量咯血1例。38例获访3～26个月，中位数为15个月。随访期间，1例发生支架远端重度狭窄，1例对侧下肢发生DVT。 结论 经大隐静脉-穿通支静脉入路行CDT治疗混合型下肢DVT，其操作简便，溶栓效率高，是临床值得推广的溶栓途径之一。
Objective To analyze the influence of the body mass index (BMI) and age on deep vein thrombosis (DVT) after the total hip arthroplasty(THA) or total knee arthroplasty(TKA) in Chinese patients who received prophylactic treatment for DVT. Methods We used a randomized clinical case-control study. From April 2004 to August 2004, weperformed THA and TKA for 95 patients (128 hips and knees). There were 27 men and 68 women with an average age of 60 years (range, 23-78) at surgery, and withan average BMI of 25.88 kg/m2 (range, 14.34-40.39) before surgery. All the patients were given low-molecular-weight heparin for 7-10 days pre-and postoperatively to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all the patients before operation and 7-10 days after operation.The patients were divided into 4 groups according to their BMI:the non-obese group (BMI≤25.00 kg/m2), the overweight group (BMI, 25.01-27.00 kg/m2), the obese group (BMI, 27.01-30.00 kg/m2), and the morbidly obese group (BMIgt;30.00 kg/m2); and they were also divided into 4 groups according to their ages (≤40, 4160, 61.70, gt;70 yr) so as to analyze the influence of the BMI and age on DVT. Results The total incidence ofDVT in all the patients was 47.4% (45/95) and the incidence of proximal DVT was 3.2%. Forty-five patients had DVT and 50 patients had no DVT. The average BMI of the patients with DVT was significantly higher than that of the patients with no DVT (Plt;005). The overweight, obese, and morbidly obese patients had an odds ratio of 7.04, 4.8,and 9.6 for DVT compared with the nonobese patients (P＜0.05); but the obese group had a less risk than the other 2 groups.The 41-60, 61-70, and gt;70-year-old patients had an odds ratio of 24.0, 38.2, and 24.4 for DVT compared with the ≤40year-old patients (P＜0.05). Conclusion Obesity (BMIgt;25 kg/m2) and an increasing age (gt;40 yr) are identified as statistically significant risk factors for DVT after THA or TKA, and patients aged 61-70 years are more likely tohave DVT than the other patients. We should pay more attention to those obesity and aged patients when they are undergoing the total joint replacement, and we should give them enough prophylaxis and closely observe the symptoms in their bilateral lower extremities after operation, taking ultrasonography or venography to check DVT if necessary, so that we can give them prompt treatment and prevent fatal pulmonary thromboembolism.
Objective To analyze the relation between the mode of delivery and postpartum lower extremity deep venous thrombosis （DVT）， and discuss the therapy methods. Methods The clinical data of 48 patients with postpartum lower extremity DVT from 2006 to 2012 in this hospital were analyzed retrospectively. Results There were 15 897 patients with the delivery， of whom were 10 097 cases of cesarean section and 5 800 cases of spontaneous delivery， the incidence rate of lower extremity DVT in the patients with cesarean section was significantly higher than that in the patients with spontaneous delivery〔0.41% （41/10 097） versus 0.12% （7/5 800）， χ2=9.94，P＜0.005〕. The higher incidence rate of cesarean section， the higher incidence rate of lower extremity DVT， which was a positive correlation between them （rs=0.87，P＜0.05）. Forty-three cases were only treated by drug therapy， 2 cases were performed operation combined with drug therapy， and 5 cases were placed the inferior vena cava filter. Forty-eight cases were cured and discharged. Conclusions The incidence rate of lower extremity DVT of cesarean section is higher as compared with the spontaneous delivery. The thrombolysis and （or） anticoagulation therapy is an effective way in the treatment for DVT. Controlling indications of cesarean section and early postpartum out-of-bed can decrease the DVT.
Objective To improve the knowledge of inflammatory bowel disease complicated with venous thromboembolism for better diagnosis and treatment. Methods One case of patient with ulcerative colitis complicated with a multiple vessel thromboembolism ( pulmonary arterial, deep vein of lower limb, and superior mesenteric vein) was analyzed, and related literatures were reviewed. Results The patient resulted in pulmonary thromboembolism ( PTE) recurrence because of irregular treatment. In addition to deep vein thrombosis of the lower extremity, a new discovery of the superior mesenteric vein embolism ( MVT) was diagnosed. The bleeding risk of heparin or lowmolecular weight heparin ( LMWH) for treatment is low, while that of warfarin is high. Conclusions Venous thromboembolism ( VTE) has a close relationship with inflammatory bowel disease ( IBD) such as ulcerative colitis. The symptomis not so typical that it is easy to misdiagnosis and missed diagnosis. It is noted that mesenteric venous thrombosis ( MVT) should be excluded in IBD patients suffering from VTE, if the source of embolus is not clear. Suitable treatment should be considered according to the risk stratification of VTE and risk-benefit ratio because of a high bleeding risk.
Objective To explore the results of thrombolytic therapy of acute deep vein thrombosis of lower extremity. Methods The clinical data of 126 patients with acute deep vein thrombosis of lower extremity treated conservatively from Dec.1999 to Feb.2004 were analyzed retrospectively. Results All patients were divided into three groups: 26 of central, 33 of surrounding and 67 of combined by Doppler sonography. Combined medication was adopted in all cases, in which 85 cases (67.5%) were clinically cured, 34 cases (27.0%) had good results, and 5 cases (4.0%) recovered partially. Two cases (1.6%) didn’t get better. The total effective rate was 98.4% (124/126). Conclusion Most patients with acute deep vein thrombosis of lower extremity can get satisfied results with conservative treatment including thrombolysis and anticoagulation. Early diagnosis and appropriate medication are crucial.
目的 比较常规使用肝素和阿加曲班治疗下肢深静脉血栓（DVT）患者的临床疗效。方法 将188例下肢DVT患者按照随机数字表分成阿加曲班组（n=94）和对照组（低分子肝素钙+尿激酶，n=94），比较2组患者治疗前、后双侧肢体周径差和疗效的差异，并在治疗过程中监测凝血指标（PT、APTT及PLT）变化。结果 阿加曲班组治疗10 d后，双侧肢体周径差较治疗前明显减小（Plt;0.05），总有效率（97.87%）优于对照组（89.37%），Plt;0.05。阿加曲班组无血小板减少症（HIT）发生，对照组发生2例HIT； 阿加曲班组PT、APTT和PLT变化均处于正常范围，与对照组比较差异无统计学意义（Pgt;0.05）。结论 阿加曲班治疗下肢DVT安全、有效。