目的

探讨静脉血栓栓塞症完整的血管造影诊断和留置导管直接溶栓治疗的价值，评价经颈静脉途径留置导管进行直接溶栓治疗急性肺动脉栓塞与深静脉血栓的价值。

方法

2008年1月至2012年8月，徐州医学院附属医院介入科收治下肢深静脉血栓形成患者645例，年龄20～84岁，平均53.9岁，全部病例给予肺动脉造影、下腔静脉造影、患肢髂股静脉造影，对发现肺动脉栓塞的患者均给予下腔静脉滤器置入，对重度和中度危险层肺动脉栓塞患者于下腔静脉放置滤器后，将猪尾导管留置于肺动脉主干或分支内进行溶栓，至肺动脉血栓完全溶解；对轻度危险层和无肺动脉栓塞患者采用保留溶栓导管于髂股静脉血栓内进行接触性溶栓。深静脉血栓溶解后取出下腔静脉滤器。

结果

645例深静脉血栓病例中，肺动脉造影检出肺动脉栓塞192例，肺动脉栓塞在深静脉栓塞患者中的发生率为29.77%。192例肺动脉栓塞患者中，轻度危险层71例，占36.97%；中度危险层16例，占8.33%；重度危险层105例，占54.69%。导管留置于肺动脉3～14d，平均6.9 d；导管留置于髂股静脉内4～19d，平均11.7 d。尿激酶用量20万～80万U/d，总用量60万～760万U，平均336万U。2例肺动脉栓塞患者死亡。急性和亚急性深静脉血栓625例，611例血栓溶解和临床评价达到优良等级。

结论

对静脉血栓栓塞症患者进行完整的血管造影诊断和保留导管溶栓治疗特别有助于抢救高危肺动脉栓塞患者，提倡对静脉血栓栓塞症患者给予完整的血管造影检查。经颈静脉保留导管直接溶栓是一项简单、安全和有效的治疗静脉血栓栓塞症的方法。

Objective

To investigate the value of integral phlebography to diagnose venous thromboembolism and to treat VTE with indwelling catheter direct thrombolysis，To evaluate the value of indwelling catheter thrombolytic therapy for acute pulmonary embolism and deep vein thrombosis via jugular vein.

Methods

Between January 2008 and August 2012，645 cases of deep vein thrombosis were treated，aged 20—84 years，mean 53.9 years old，the angiography of pulmonary，inferior vena cava and onset iliac-femoral was performed respectively in all cases.The inferior vena cava filter was implanted for patients with pulmonary embolism in those cases.For patients of high risk strategies and moderate strategies PE，after the implantation of inferior vena cava filter，a pigtail catheter indwelled in pulmonary artery or its branches for thrombolysis until the pulmonary artery thrombus completely dissolved.For patients with mild strategies PE or no PE，direct thrombolysis was performed via indwell thrombolytic catheter in iliofemoral venous thrombosis，the inferior vena cava filter was removed after completely dissolve of iliac-femoral thrombose.

Results

192 cases of pulmonary embolism were detected in pulmonary angiography of 645 cases of deep venous thrombosis，incidence of pulmonary embolism was 29.77%in our patients.In 192 cases of pulmonary embolism，mild risk strategies was 71，the ratio was 36.97%，moderate risk strategies was 16，the ratio was 8.33%，the high risk strategies was 105，the ratio was 54.69%.The catheter indwelled in the pulmonary artery for 3-14 days，average 6.9 days，in iliac femoral vein 4—19 days，average 11.7 days.0.2 million—0.8 million units urokinase were perfused via indwelling catheter each day，the total dosage of urokinase was 0.6 million—7.6 million units，average of 3.36 million units.Two cases of PE died.The clinic effect in 611 patients were satisfactory among 625 patients with acute and subactive iliac femoral thrombosis.

Conclusions

It is a reliable process that the integral angiographic diagnosis and indwelling catheter direct thrombolysis to rescue the acute high risk PE.The integral angiography should be advocated to the patient with VTE.It is a simple、safe and effective method that Via jugular vein approach indwelling catheter direct thrombolysis to treat the VTE.