腔静脉滤器植入联合导管溶栓术治疗下肢深静脉血栓的疗效分析

目的:探讨腔静脉滤器植入联合导管溶栓术治疗下肢深静脉血栓患者的临床疗效及安全性。方法:回顾性分析2012年10月~2014年10月来我院住院治疗的80例下肢深静脉血栓形成患者的临床资料,根据治疗方式及溶栓途径的差异分为两组,比较两组患者治疗前后下肢周径差变化、静脉通畅率、血栓后综合征情况及治疗后并发症的发生情况。结果:治疗后,两组患者下肢平均周径均有所减少,肿胀明显缓解,静脉通畅度评分显著降低,较治疗前差异有统计学意义(P0.05);其中,观察组患者下肢消肿率更为明显,静脉通畅度更好,较对照组差异有统计学意义(P0.05)。治疗后对照组患者PTS发生例数为9例(23.68%),观察组PTS发生率更低仅为1例(2.38%),差异有统计学意义(P0.05)。两组患者治疗后均出现并发症,但发生率比较无明显统计学意义(P0.05)。结论:采用腔静脉滤器植入联合导管溶栓术治疗下肢深静脉血栓可使静脉阻塞部位尽早恢复通畅,减少瓣膜功能损害,降低PTS等并发症的发生率。     

导管接触性溶栓同期球囊扩张+支架治疗血栓性髂静脉压迫综合征的疗效

摘要 目的：为提高治疗效率,本研究对髂静脉压迫综合征合并下肢深静脉血栓患者的导管接触溶栓同期球囊扩张+支架治疗方案和分期治疗方案进行比较。方法：以65例髂静脉压迫综合征合并下肢深静脉血栓患者为研究对象,根据治疗方法分为研究组和对照组,研究组32例,进行导管接触溶栓同期球囊扩张+支架治疗,对照组33例,进行导管接触溶栓分期球囊扩张+支架治疗。以治疗前后患者大腿围、小腿围、血管通畅评分,手术指标（住院时间、住院次数、溶栓时间及穿刺次数）,并发症（血栓复发、出血以及肺栓塞）及深静脉血栓后遗症为指标,考察两组疗效。结果：两组患者大腿围、小腿围和静脉畅通评分在治疗前均无显著差异（P＞0.05）,经过治疗,两组大腿围、小腿围和静脉畅通评分均显著改善（P＜0.05）,但两组间各项指标无显著差异（P＞0.05）。研究组患者住院时间、住院次数、溶栓时间及穿刺次数均显著低于对照组（P＜0.05）。研究组血栓复发0例,对照组血栓复发4例,有显著差异（P＜0.05）;研究组出血1例,肺栓塞0例,对照组出血2例,肺栓塞0例,两组出血和肺栓塞情况比较,无显著差异（P＞0.05）。研究组PTS发生率为6.25 %,显著低于对照组的18.18 %（P＜0.05）。结论：导管接触溶栓同期球囊扩张+支架治疗方案对髂静脉压迫综合征合并下肢深静脉血栓有良好的疗效。     

腔静脉滤器植入、溶栓及手术治疗下肢深静脉血栓形成

目的:探讨下肢深静脉血栓形成的有效治疗方法。方法:回顾性分析1988年4月-2006年10月间治疗的255例下肢深静脉血栓形成的临床资料。直接患肢深静脉溶栓74例,手术取栓12例,抗凝等治疗169例,下腔静脉滤器植入32例(均为永久性滤器)。结果:随访2～126个月,平均64个月。31只下腔静脉滤器均展开良好,有1例临时滤器移位至下腔静脉近心端,其他无移位。1例永久性滤器植入14个月后滤器中血栓形成。溶栓组显效52例,有效20例,无效2例。手术组显效10例,有效2例,无效0例。两种治疗方法比较,显效率有显著差别(P＜0．05),总有效率无显著差别。结论:腔静脉滤器植入能有效预防肺动脉栓塞,但应严格掌握适应证。手术治疗是提高疗效和预防后遗症的有效方法。     

经皮导管接触溶栓腔内治疗与标准抗凝治疗用于急性下肢深静脉血栓的临床效果比较

目的:分析和比较经皮导管接触溶栓腔内治疗与单纯标准抗凝治疗急性下肢深静脉血栓形成的临床效果的安全性。方法:回顾性分析93例中央型(髂股静脉)和混合型(全下肢深静脉)深静脉血栓患者临床资料,根据治疗方法的不同分为导管溶栓治疗组(试验组)65例、单纯抗凝治疗组(对照组)28例,比较两组患者治疗后患肢消肿率、下肢深静脉血栓的溶栓率及并发症的发生率。结果:治疗后,试验组患者患肢大腿消肿率[(83.03±4.53)%]显著高于对照组[(50.42±7.41)%](P0.05);患肢小腿消肿率[(76.48±8.24)%]亦显著高于对照组(54.95±8.14)%(P0.05)。试验组患者下肢深静脉血栓溶栓有效率为92.31%(60/65),显著高于对照组[14.29%(4/28)](P0.05)。随访半年后,试验组患者下肢血管的通畅率为90.67%(57/65),PTS率为7.69%(5/65);而对照组患者下肢血管的通畅率为21.42%(6/28),PTS率为14.28%(4/28)。试验组血管通畅率明显高于对照组(P0.05),而PTS发生率明显低于对照组(P0.05)。两组患者并发症发生率比较差异无明显统计学意义(P0.05)。结论:经皮导管接触溶栓腔内治疗急性中央型和混合型下肢深静脉血栓的短期疗效优于单纯抗凝治疗,且两种方法的安全性相当。     

髋关节置换术前合并深静脉血栓行下腔静脉滤器置入的护理对策

目的探讨髋关节置换术前合并深静脉血栓(DVT)行下腔静脉滤器置入的护理对策。方法回顾性分析2015年6月～2017年12月我科行髋关节置换术的495例患者的临床资料,其中10例出现术前合并DVT。10例患者于手术当天预先置入下腔静脉滤器(未行溶栓术),术后连续给予35d利伐沙班抗凝治疗。根据血栓形成的时间给予针对性心理干预与个性化护理对策。观察患者术口感染、血肿形成、二次DVT形成、肺栓塞及术后1年髋关节功能恢复情况。采用焦虑自评量表(SAS)、生活满意指数A量表(LSIA)、Harris评分量表分别评估患者干预前后焦虑情绪、生活满意情况与髋关节功能。结果所有患者术后均未出现术口感染、血肿、二次DVT和肺栓塞,4例出现轻微下肢肿胀。患者干预后SAS、LSIA、Harris评分与术前比较,差异均有统计学意义(t=8.588、-7.008、-32.566,P0.05)。结论在髋关节置换术前合并DVT治疗中置入腔静脉滤器可有效降低患者肺栓塞发生率,针对性心理干预与个性化护理可缓解患者的焦虑情绪,增加其生活满意度,促进髋关节功能恢复。     

导管接触溶栓与机械辅助吸栓治疗急性髂股静脉血栓的对比研究

目的:评价导管接触溶栓与机械辅助吸栓治疗急性髂股静脉血栓的临床效果。方法:回顾性分析162例急性下肢深静脉血栓(髂股静脉血栓)形成患者临床资料,其中导管溶栓治疗组(A组)80例、机械辅助吸栓组(B组)82例,比较两组患者治疗后患肢深静脉溶栓率、消肿率、并发症发生率、治疗时间的差异。结果:急性下肢髂股静脉血栓溶栓率B组(46.45±11.56)%显著高于A组(32.05±10.7)%(P0.05)。患肢消肿率B组(68.68±10.75)%和A组(41.34±11.26)%有明显统计学差异(P0.05)。两组并发症发生率无明显统计学意义。两组溶栓时间A组明显长于B组,两组间比较有明显统计学差异。结论:机械辅助吸栓治疗急性髂股静脉血栓早期疗效好于导管接触溶栓。     

下肢深静脉血栓形成及其并发症38例护理体会

目的探讨下肢深静脉血栓形成及其并发症的护理措施,以提高护理质量。方法对我科收治的38例下肢深静脉血栓形成行溶栓治疗患者的临床资料进行回顾性分析。结果 38例下肢深静脉血栓形成患者经溶栓治疗及精心护理后,患者临床症状明显缓解、痛苦减轻,未发生肺动脉栓塞。结论下肢深静脉血栓形成患者通过溶栓治疗及实施持续有效的护理措施,避免了肺动脉栓塞的发生,提高患者生存质量的同时也提高了护理满意度。     

下肢深静脉血栓形成的危险因素及导管接触性溶栓的临床疗效研究

目的:分析下肢深静脉血栓形成(DVT)的危险因素,并探讨导管接触性溶栓治疗下肢DVT的临床疗效。方法:选取2015年12月～2018年12月间在北京积水潭医院治疗的126例下肢DVT患者作为病例组,另外选取同期在我院健康体检的志愿者60例作为对照组,采用多因素Logistic回归分析下肢DVT的危险因素。将病例组按随机数表法分为系统溶栓组(采用系统性溶栓治疗)和导管溶栓组(采用导管接触性溶栓治疗)两个亚组,各63例。评价两组疗效,观察两组患者治疗前及治疗1个月后的双下肢周径差和静脉通畅度评分,记录并比较两组患者治疗时间、住院时间、尿激酶用量以及不良反应发生情况。结果:病例组与对照组年龄、体质量指数(BMI)、红细胞计数(RBC)、手术外伤史比较,差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,年龄、BMI、RBC、手术外伤史均是下肢DVT的独立危险因素(P0.05)。导管溶栓组痊愈率为57.14%(36/63),高于系统溶栓组的33.33%(21/63)(P0.05);治疗1个月后,两组双侧大腿周径差、双侧小腿周径差以及静脉通畅度评分均明显减小,且导管溶栓组上述指标均明显小于系统溶栓组(P0.05)。导管溶栓组治疗时间和尿激酶用量明显少于系统溶栓组,但住院时间明显长于系统溶栓组(P0.05)。两组患者不良反应发生率比较差异无统计学意义(P0.05)。结论:年龄、BMI、RBC、手术外伤史均是下肢DVT的独立危险因素,导管接触性溶栓治疗下肢DVT的疗效显著,具有较好的安全性。     

腓肠肌挤压配合踝泵运动预防术后下肢深静脉血栓(DVT)形成的临床观察

目的探讨腓肠肌挤压配合踝泵运动预防术后下肢深静脉血栓(DVT)的效果,研究其临床价值。方法将2013年7月~2014年6月行手术治疗的362例在常规护理基础上实施腓肠肌挤压配合踝泵运动护理干预的患者为观察组,2011年7月~2012年6月单独实施常规护理干预措施的393例手术患者为对照组,并对两组的静脉血栓发生率、平均住院费用、平均住院时间进行比较。结果观察组下肢深静脉血栓形成发生率为2.2%,明显低于对照组的4.1%,差异具有统计学意义(χ2=0.025,P0.05)。而且观察组患者平均住院费用及平均住院时间均少于对照组,差异具有统计学意义(P0.05)。结论实施腓肠肌挤压配合踝泵运动后显著降低了术后患者下肢深静脉血栓的发生率,减轻了患者的痛苦及经济负担,避免了诱发肺栓塞的可能性,提高了治疗效果。     

子宫动脉栓塞术后并发血栓的临床病例分析和诊治探讨

目的:探讨剖宫产瘢痕妊娠(CSP)患者经子宫动脉栓塞术(UAE)后并发下肢深静脉血栓(DVT)的临床病例的诊断治疗要点。方法:回顾性分析2014年-2016年我院收治的剖宫产瘢痕妊娠患者经子宫动脉栓塞术后并发下肢深静脉血栓(DVT)5例患者的临床特点及诊断、治疗方法。结果:2014年-2016年,我院CSP患者经UAE治疗后发生DVT的发病率为1.63%,患者平均年龄35.2岁。DVT临床症状出现于UAE术后3-6天,多表现为下肢的疼痛及酸胀,深静脉血栓均出现在介入穿刺处肢体。用彩色多普勒血流显像诊断深静脉血栓安全可靠。采用低分子肝素皮下注射抗凝治疗均取得较好效果。结论:剖宫产瘢痕妊娠患者经子宫动脉栓塞术治疗后有发生下肢深静脉血栓风险,DVT发生与穿刺处肢体制动,血管受压,血液回流障碍有关。手术前后应采取预防措施,低分子肝素钠抗凝对DVT治疗有效。     

Use of DIL-type cava filters for the prevention of thromboembolism of the pulmonary artery]

New type cava filters were employed to prevent pulmonary artery thromboembolism in 12 cases. DIL cava filter was used, that represents a string made of a special alloy that can 'memorize' its shape. The design of this filter is in principle different from all the known filters, for it functions as an intraluminal filter and at the same time stretches the vena cava inferior, enlarging its diameter in the frontal plane. The DIL cava filter proved to be effective in the majority of cases, but if the walls of vena cava inferior were too rigid, for example, if a tumor grew into them, it was difficult to place the filter properly. On the whole this filter is characterized by a number of advantages: it can be easily implanted via 7 F catheter without injuring the vena cava inferior walls. No cases of dislocation of cava filters in relation to bone markers were noted in 9 patients over 60 +/- 17 days.     

对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流诊断中的应用

摘要 目的：对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流（APVC）诊断中的应用价值。方法：采用回顾性分析方法,2019年1月到2022年1月选择在本院进行诊治的胎儿肺静脉异位引流孕妇60例作为研究对象,都给予四维容积超声及彩色多普勒超声,记录影像学特征并判断诊断价值。结果：在60例孕妇中,彩色多普勒超声检查判断为胎儿肺静脉异位引流51例,诊断敏感性为85.0 %;四维容积超声检查判断为胎儿肺静脉异位引流59例,诊断敏感性为98.3 %,四维容积超声检查对胎儿肺静脉异位引流的诊断敏感性明显高于彩色多普勒超声检查（P<0.05）。彩色多普勒超声检查与四维容积超声检查诊断的特异性都为100.0%。在60例孕妇中,判断为胎儿肺静脉异位引流心上型32例,心下型28例;心上型的肺静脉引流途径为肺静脉-垂直静脉-右上腔静脉22例、肺静脉-垂直静脉-左上腔静脉10例,心下型的肺静脉引流途径为肺静脉-垂直静脉-左头臂静脉-右上腔静脉6例、肺静脉-垂直静脉-门静脉22例。合并心脏畸形32例,合并畸形率为53.3 %;有51例孕妇终止妊娠,9例孕妇继续妊娠,其中8例未经治疗者新生儿期死亡,1例在3月龄死亡。结论：相对于彩色多普勒超声,四维容积超声在胎儿肺静脉异位引流诊断中的应用可提高诊断敏感性,可有效反映肺静脉回流情况,可指导临床进行早期干预。     

Diagnosis of deep vein thrombosis using autologous indium-III-labelled platelets.

Forty-eight patients who had undergone surgical reduction of a fractured neck of femur or in whom deep vein thrombosis was suspected clinically were studied by ascending phlebography and imaging after injection of autologous indium-111-labelled platelets to assess the accuracy and value of the radioisotopic technique in diagnosing deep vein thrombosis. Imaging was performed with a wide-field gammacamera linked with data display facilities. Phlebography showed thrombi in 26 out of 54 limbs examined and a thrombus in the inferior vena cava of one patient; imaging the labelled platelets showed the thrombi in 24 of the 26 limbs and the thrombus in the inferior vena cava. The accumulation of indium-111 at sites corresponding to those at which venous thrombi have been shown phlebographically indicates that this radioisotopic technique is a useful addition to methods already available for the detection of deep vein thrombosis.     

Left sided inferior vena cava duplication and venous thromboembolism: case report and review of literature

The etiology of venous thromboembolism in young patients is frequently associated with hereditary coagulation abnormalities, immunologic diseases, and neoplasia. The advent of radiological advances, namely Computed Tomography (CT) scans and venography has identified vena cava malformations as a new etiologic factor worthy of consideration. In this case report, we describe the unusual occurrence of venous thromboembolism in association with a duplicated inferior vena cava. Duplications of the inferior vena cava (IVC) are seen with an incidence of 0.2% to 3.0% in the general population. Embryogenesis of the IVC is a complex process involving the intricate formation and regression of numerous anastomoses, potentially leading to various anomalies. We present a 23-year-old Caucasian woman with IVC duplication who developed a deep venous thrombosis and multiple pulmonary emboli. Anomaly of the IVC is a rare example of a congenital condition that predisposes to thromboembolism, presumably by favoring venous stasis. This diagnosis should be considered in patients under the age of 30 with spontaneous occurrence of blood clots.     

经膝下途径导管直接溶栓治疗混合型下肢深静脉血栓形成

目的:评价经膝下(Below the Knee, BTK)途径导管直接溶栓(Catheter-Directed Thrombolysis, CDT)治疗混合型下肢深静脉血栓形成(Deep Vein Thrombosis, DVT)的安全性和有效性。方法:回顾性分析2013年1月至2017年10月于徐州市肿瘤医院介入科接受经BTK途径CDT治疗的38例急性混合型DVT患者临床资料,其中男性患者26例,女性患者12例,年龄54±11岁。结果:技术成功率为100%。经小隐静脉穿刺途径28例,小隐静脉切开途径4例,胫后静脉切开途径4例,胫后静脉穿刺途径2例。行CDT前,所有患者均接受临时可回收滤器置入,并于术后2周内取出。36名患者DVT血栓溶解成功(Ⅱ和Ⅲ级)。2名未获得血栓溶解成功的患者,从症状发生到CDT时间均大于10天。对13例患者(左侧10例,右侧3例)进行髂静脉球囊扩张和支架植入。围手术期出现切口渗血4例,切开部位麻木5例,没有新发肺栓塞和大出血发等主要并发症。平均随访时间为2年(1个月-4年),28例患者超过1.5年。2例患者由于未服用华法林而出现反复髂股DVT。随访期间通畅率和PTS率分别为81.6%(31/38)和31.6%(12/38)。结论:采用经BTK途径行CDT治疗混合型DVT是安全有效的,围手术期及随访期间结果满意,是一种值得推广的方法。     

Anatomic Twist to a Straightforward Ablation

Atrioventricular (AV) junction ablation for treatment of refractory atrial fibrillation is a well defined, standardized procedure and the simplest of commonly performed radiofrequency ablations in the field of cardiac electrophysiology. We report successful AV junction ablation using an inferior approach in a case of inferior vena cava interruption. Inability during the procedure to initially pass the ablation catheter into the right ventricle, combined with low amplitude electrograms, led to suspicion of an anatomic abnormality. This was determined to be a heterotaxy syndrome with inferior vena cava interruption and azygos continuation, draining in turn into the superior vena cava. Advancing Schwartz right 0 (SRO) sheath through the venous abnormality into the right atrium allowed adequate catheter stability to successfully induce complete AV block with radiofrequency energy.     

Heterotopic heart transplantation in mice

The mouse heterotopic heart transplantation has been used widely since it was introduced by Drs. Corry and Russell in 1973. It is particularly valuable for studying rejection and immune response now that newer transgenic and gene knockout mice are available, and a large number of immunologic reagents have been developed. The heart transplant model is less stringent than the skin transplant models, although technically more challenging. We have developed a modified technique and have completed over 1000 successful cases of heterotopic heart transplantation in mice. When making anastomosis of the ascending aorta and abdominal aorta, two stay sutures are placed at the proximal and distal apexes of recipient abdominal aorta with the donor s ascending aorta, then using 11-0 suture for anastomosis on both side of aorta with continuing sutures. The stay sutures make the anastomosis easier and 11-0 is an ideal suture size to avoid bleeding and thrombosis.When making anastomosis of pulmonary artery and inferior vena cava, two stay sutures are made at the proximal apex and distal apex of the recipient s inferior vena cava with the donor s pulmonary artery. The left wall of the inferior vena cava and donor s pulmonary artery is closed with continuing sutures in the inside of the inferior vena cava after, one knot with the proximal apex stay suture the right wall of the inferior vena cava and the donor s pulmonary artery are closed with continuing sutures outside the inferior vena cave with 10-0 sutures. This method is easier to perform because anastomosis is made just on the one side of the inferior vena cava and 10-0 sutures is the right size to avoid bleeding and thrombosis. In this article, we provide details of the technique to supplement the video.