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。
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.
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.
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.
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 summarize the clinical manifestation and the causes of lower limb deep venous thrombosis （DVT） complicated with pulmonary embolism （PE）. Method The clinical data of 45 cases of PE confirmed by CTPA from May 2009 to May 2012 in this hospital were summarized retrospectively. Results Five patients with PE had no obvious clinical manifestation， 9 patients （20.0%） had chest stuffiness and short of breath， 8 patients （17.8%） had cough. In the causes of thrombosis defluxion：11 patients （24.4%） had early mobilization after operation， 9 patients （20.0%） had functional exercise after operation， 7 patients （15.6%） had turn over or defecate on bed， 2 patients （4.4%） had sneeze， 14 patients （31.1%） had no definite causes. Conclusions Patients with lower limb DVT have high risk of thrombosis defluxion， although adequate anticoagulation. Early mobilization， functional exercise， and transient increased abdominal pressure are easy to lead to thrombosis defluxion， so lead to PE. Absence of the protection of inferior vena cava filter， patient should be required for bed ridden in order to avoid the thrombosis defluxion.
ObjectiveTo explore the correlation between the Barthel index score and other factors with the preoperative occurrence of deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA) revision surgery. MethodsA retrospective analysis was conducted on clinical data from 122 patients who met the inclusion criteria and underwent THA revision surgery between April 2017 and November 2020. Among them, 61 were male and 61 were female, with an age range of 32-85 years (mean, 65.3 years). The reasons for revision included prosthetic joint infection in 7 cases, periprosthetic fracture in 4 cases, prosthetic dislocation in 6 cases, and aseptic loosening in 105 cases. The Barthel index score was 76.4±17.7, with 10 cases classified as level 1, 57 as level 2, 37 as level 3, and 18 as level 4. Univariate analysis was performed on variables such as age, gender, body mass index, Barthel index score, preoperative D-dimer positivity, history of diabetes, hypertension, cancer, cerebral infarction, smoking, and thrombosis in patients with and without preoperative DVT. Furthermore, logistic regression was used to identify risk factors for preoperative DVT in THA revision surgery. The incidence of preoperative DVT was compared among different Barthel index score groups. ResultsPreoperative DVT was detected in 11 patients (9.02%), all of whom had intermuscular venous thrombosis. Among them, 1 had prosthetic joint infection, 1 had periprosthetic fracture, 1 had prosthetic dislocation, and 8 had aseptic loosening. Univariate analysis showed significant differences between the two groups in terms of age, gender, and Barthel index score (P<0.05). logistic regression further revealed that female, age ≥70 years, and Barthel index score<60 were independent risk factors for preoperative DVT in patients undergoing THA revision surgery (P<0.05). The incidence of preoperative DVT in patients with Barthel index scores of levels 1, 2, 3, and 4 were 0 case (0%), 2 cases (3.5%), 3 cases (8.1%), and 6 cases (33.3%), respectively. A significant correlation was found between Barthel index score classification and the incidence of preoperative DVT in patients undergoing THA revision surgery (χ2=10.843, P=0.001). ConclusionIn patients undergoing THA revision surgery, older age, female, and lower Barthel index scores are associated with higher preoperative DVT incidence. For patients with low preoperative Barthel index scores, preoperative thrombosis screening should be emphasized.
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.
Objective To investigate the short-term result of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (DVT) in lower extremity. Methods A total of 289 cases of acute DVT in lower extremity who got treatment in Nanjing Drum Tower Hospital Group Suqian City People’s Hospital and Xuzhou Central Hospital from March 2013 to December 2014 were enrolled prospectively, and of them, 125 cases of system thrombolysis (ST) group underwent ST, 164 cases of CDT group underwent inferior vena cava filter placement (IVCF)+CDT. Clinical effect was compared between the 2 groups. Results Clinical symptoms of all cases were obviously relieved, and limb swelling was significantly reduced. Of the CDT group, 73 cases presented iliac vein compression syndrome (IVCS), and 43 cases of them underwent the percutaneous transluminal angioplasty and stent implantation. In CDT group, there was 1 case complicated by catheter displacement, 10 cases suffered from puncture site ecchymosis, 3 cases suffered from hematuria. In ST group, there was 1 case suffered from pulmonary embolism (PE), 14 cases suffered from bleeding gums, 22 cases suffered from hematuria, 3 cases suffered from skin and mucosa petechia, and 2 cases suffered from melena (didn’t need transfusion). The morbidity of ST group was higher than that of CDT group (P=0.002). There were 18 cases suffered from recurrence in ST group, 15 cases suffered from recurrence in CDT group, but there was no significant difference in the recurrence rate between the 2 groups (P=0.786). In addition, the dosage of urokinase, thrombolysis time, blood vessel patency score, thigh circumference after treatment, and calf circumference after treatment in ST group were all higher than those of CDT group (P<0.050), but the Villalta score in ST group was lower than that of CDT group (P<0.001). There was no significant difference in hospital stay (P=0.383). Conclusion For acute DVT in lower extremity, CDT has a superior short-term outcome with safety and feasibility.
Objective To study the significance of the levels of plasma inflammatory cytokines (IL-6，IL-8，IL-10 and TNF-α) in patients with acute deep venous thrombosis (DVT) of lower extremity. Methods Forty untreated DVT cases were selected as the subjects in the DVT group, while thirty healthy subjects, whose ages and genders showed no significant difference with the DVT patients, were collected as the control group. The plasma levels of IL-6, IL-8 and TNF-α were detected by radioimmunoassay (RIA), and the plasma level of IL-10 was measured by enzyme-linked immunosorbent assay (ELISA). Correlation analysis was used to investigate the relationships between the levels of different inflammatory cytokines within DVT group. Results The levels of plasma cytokines in the DVT group were all significantly higher than those in control group (P＜0.001). The results of the correlation analysis showed that there were positive correlations between IL-6 and TNF-α (r=0.383, P＜0.05), IL-10 and TNF-α (r=0.390, P＜0.05), respectively, within the DVT group; whereas there were no correlations between IL-6 and IL-8, IL-6 and IL-10, IL-8 and IL-10, and IL-8 and TNF-α. Conclusion The levels of plasma cytokines increased significantly in patients of DVT. Inflammatory cytokines may play an important role in acute DVT by accelerating the pace of thrombosis, intensifying the inflammatory reaction around thrombus and aggravating the injured blood vessel.