【摘要】 目的　报告 12例肺动脉血栓栓塞症 (PTE)的介入治疗结果 ,评价介入技术治疗PTE的安全性和疗效。资料与方法　 12例确诊为PTE的患者进行了介入治疗 ,男 9例 ,女 3例 ,年龄 2 6～ 78岁。就诊时临床症状 :休克 3例 ,咯血 9例次 ,胸痛和呼吸困难 12例次。 11例合并下肢深静脉血栓 (DVT) ,1例上肢静脉血栓。全部患者作胸部CT增强扫描和肢体超声波检查。治疗方法有经导管肺动脉内留置导管溶栓 4例次 ,用导管捣碎、抽吸血栓和局部溶栓 12例次 ,经导管肺动脉消融术 2例次 ,腔静脉过滤器置入术 12例次。结果　 12例患者治疗 16例次 ,无并发症发生。 4例先行经导管肺动脉内溶栓术 ,因效果不明显而用导管捣碎、抽吸血栓 ;8例采用机械性措施 (捣碎、抽吸、消融 )清除血栓 ,辅以局部溶栓。结束治疗时复查肺动脉造影 ,10例肺动脉内血栓被大部分清除、中央分支血流恢复 ,症状明显改善 ,血氧饱和度从术前平均 82 %增至 94 %。 2例治疗后肺动脉造影有改善 ,但临床症状改善不明显。术后随访时间 4～ 36个月 ,患者未再出现PTE复发症状。结论　单纯行肺动脉内留置导管溶栓对治疗PTE效果不佳。机械性清除血栓技术 ,包括经导管血栓抽吸、捣碎和消融 ,联合局部溶栓术 ,是治疗PTE的安全、有效方法。更多还原

【Abstract】 Objective To evaluate the safety and effect of interventional therapy for pulmonary thromboembolism (PTE).Materials and Methods Interventional management was carries out in 12 patients with confirmed PTE (9 males and 3 females, aged 26～78 years). The initial symptoms included shock (n=3), hemoptysis (n=9) and chest pain with dyspnea (n=12). Deep vein thrombosis (DVT) of the lower and upper extremities was accompanied in 11 and one cases, respectively. Thoracic enhanced CT scanning and Doppler sonography of the extremities were performed in all cases. The interventional managements included transcatheter intrapulmonary arterial thrombolysis (n=4), combination of transcatheter fragmentation and aspiration of the thrombus together with local infusion of urokinase (n=12), transcatheter pulmonary ablation (n=2), and placement of filter in the vena cava (n=12).Results Sixteen interventional procedures were performed in 12 cases. No significant complications occurred. In 4 cases, transcatheter fragmentation and aspiration of the thrombus was further carried out because initial transcatheter intrapulmonary arterial thrombolysis showed no obvious effect, both clinically and angiographically. Eight patients underwent catheter-directed mechanical fragmentation, aspiration and ablation of the thrombus with urokinase infusion. Check-up angiography after the procedures showed that most thrombus in the pulmonary artery was cleared out and pulmonary flow was restored in 10 cases, with the systemic arterial oxygen saturation being increased from 82% to 94%. In two cases, angiographic improvement was observed but no obvious clinical improvement occurred. During 4～36 months follow-up, all patients remained asymptomatic.Conclusion Transcatheter intrapulmonary arterial thrombolysis alone has limited effect on PTE. Interventional mechanical thrombus-clearing technique, i.e. fragmentation, aspiration and ablation of the thrombus with local thrombolysis, is an effective and safe technique for the treatment of PTE.更多还原