AcoStream与AngioJet治疗急性髂股静脉血栓形成的疗效比较

doi:10.11958/20240740

摘要/Abstract

摘要：

目的探讨AcoStream和AngioJet两种血栓清除装置治疗急性髂股静脉血栓形成（AIFVT）的临床疗效和安全性。方法 97例AIFVT患者根据病情采用不同的血栓清除装置治疗，分为AcoStream组（41例）和AngioJet组（56例）。比较2组血栓清除情况、患肢消肿程度、手术时间、术中失血量、是否需辅助导管接触性溶栓（CDT）治疗、尿激酶用量、髂静脉支架置入、并发症发生情况、住院时间、住院费用等指标。定期随访记录有无血栓复发，评估支架通畅情况，有无下肢深静脉血栓后综合征（PTS）及PTS程度。结果 2组患者性别、年龄、患肢、发病时间、股青肿、血栓范围和发病诱因差异均无统计学意义（P>0.05）。2组患者手术均成功，血栓清除效果满意，血栓清除率、术后48 h患肢消肿程度、行辅助CDT、支架置入率、住院时间差异均无统计意义（P>0.05）。与AcoStream组相比，AngioJet组手术时间延长，术中失血量减少，住院费用增高，并发症发生率升高（P<0.05）。2组血栓复发率差异无统计学意义（P>0.05），且均无髂静脉支架闭塞和中、重度PTS发生。结论 AcoStream和AngioJet两种机械性血栓清除装置治疗AIFVT均安全、有效。

关键词: 血栓形成, 髂股静脉, 机械血栓清除, AcoStream, AngioJet

Abstract:

Objective To investigate the clinical efficacy and safety of two thrombus thrombectomy devices, AcoStream and AngioJet, in the treatment of acute iliofemoral vein thrombosis (AIFVT).Methods A total of 97 AIFVT patients were treated with different thrombus clearing devices according to their states of illness, and patients were divided into the AcoStream group (41 cases) and the AngioJet group (56 cases). The thrombus clearing status, degree of swelling reduction in affected limb, surgical time and intraoperative blood loss were compared between the two groups, and the need for assisted catheter contact thrombolysis (CDT) treatment, urokinase dosage, iliac vein stent placement, incidence of complications, length of hospital stay and hospitalization costs were also compared between the two groups. Regular follow-up was conducted to record for recurrence of thrombosis, the patency of the stent, deep vein thrombosis syndrome (PTS) and PTS degree were evaluated in lower limbs.Results There were no significant differences in age, gender, affected limb, time of illness, site of illness and causes of illness between the two groups (P>0.05). The operation was successful in both groups and the thrombus removal effect was satisfactory. There were no significant differences in terms of thrombus clearance rate, the degree of swelling reduction in the limb 48 hours after surgery and assisted CDT rate between the two groups (P>0.05). Compared with the AcoStream group, the AngioJet group had a longer surgical time, reduced intraoperative blood loss, increased hospitalization costs and higher rates of complications (P<0.05). There was no significant difference in the recurrence rate of thrombosis between the two groups (P>0.05), and there was no occurrence of iliac vein stent occlusion or PTS in either patients.Conclusion Two mechanical thrombus clearing devices of AcoStream and AngioJet are safe and effective for treating AIFVT.

Key words: thrombosis, iliofemoral vein, mechanical thrombus clearance, AcoStream, AngioJet

中图分类号:

R654.4

图/表 4

图1 左侧AIFVT行AcoStream血栓抽吸情况 A：俯卧位，造影显示左侧急性髂股静脉血栓形成；B：行AcoStream血栓抽吸后髂总静脉狭窄；C：髂总静脉狭窄处给予球囊扩张成形术；D：支架置入后血流通畅；E：吸出的血栓。

Fig.1 AcoStream thrombus aspiration in left AIFVT

图2 左侧AIFVT行AngioJet血栓抽吸情况 A：仰卧位，造影显示左侧急性髂股静脉血栓形成；B：行AngioJet血栓抽吸后髂总静脉狭窄；C：髂总静脉狭窄处给予球囊扩张成形术；D：支架置入后血流通畅；E：AngioJet机器及吸出的血栓。

Fig.2 AngioJet thrombus aspiration for left AIFVT

表1 2组患者临床资料比较

Tab.1 Comparison of clinical data between two groups of patients

组别	股青肿			血栓范围（A/B/C）		发病诱因（A/B/C/D/E）
组别		n	性别（男/女）		年龄/ 岁		患肢（左/右）	发病时间/d
AcoStream组		41	18/23		56.4±11.6		33/8	5.5±2.3
AngioJe组		56	24/32		53.2±10.9		46/10	4.6±2.9
χ²或t			0.998		0.123		0.252	0.06
AcoStream组	1（2.4）			13/15/13		11/6/9/3/12
AngioJe组	2（3.6）			15/20/21		15/8/13/4/16
χ²	0.104			0.430		0.373

表2 2组患者手术相关指标比较

Tab.2 Comparison of intraoperative and postoperative clinical indicators between two groups of patients

组别	n	血栓清除率（Ⅲ/Ⅱ/Ⅰ）		手术时间/ min	患肢消肿程度/cm		辅助CDT		失血量/mL
AcoStream组	41	30/10/1		63.6±15.4	3.0±0.8		11（26.8）		255.5±67.5
AngioJet组	56	42/13/1		90.7±17.2	3.1±0.8		18（32.2）		137.9±73.1
t或χ²		0.073		5.945^＊	1.990		0.693		9.219^＊
组别		尿激酶总用量/万U	支架置入率			住院时间/d		住院费用/元
AcoStream组		30.5±18.5	22（53.7）			5.8±1.7		32 476.2±3 319.8
AngioJet组		57.5±14.5	33（58.9）			5.3±1.4		56 791.6±5 116.3
t或χ²		17.572^＊	0.268			0.454		10.274^＊

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