摘要
探讨亚急性下肢深静脉血栓(LEDVT)的治疗策略。首先介绍DVT的定义、发病率以及临床分期,强调血栓形成后的病理变化和临床病程的滞后性。讨论亚急性DVT的诊断方法,包括静脉超声检查、超微血管成像(SMI)、超声二维剪切波弹性成像(2D-SWE)和静脉造影等,指出这些技术在判断血栓性质和分期方面的重要性。在治疗方面,强调抗凝治疗的基础作用,并提到血管活性药物和类肝素抗栓药物的辅助治疗效果。介绍腔内血栓清除治疗技术,包括导管接触性溶栓(CDT)、经皮机械血栓清除术(PMT)和大腔导管手动抽吸(MAT)等方法,并引用多项临床研究结果,展示这些技术在亚急性DVT治疗中的有效性和安全性。最后,文章展望亚急性DVT诊治的未来研究方向,包括开发新型分子影像技术、建立血栓机化程度与治疗效果的关联模型、探索抗凝联合血管活性药物的作用,以及利用人工智能进行预后预测等。文章强调,随着精准医学的发展,亚急性DVT的诊疗有望从经验性模式转向基于血栓生物学特性的分层管理,以改善病人的远期预后。
In this article we primarily explored the treatment strategies for subacute lower extremity deep vein thrombosis(LEDVT).We introduced the definition,incidence,and clinical stage of DVT,emphasized the pathological changes following thrombosis and the lag in the clinical course,discussed diagnostic methods for subacute DVT,including venous ultrasound examination,super‐microvascular imaging(SMI),two‐dimensional shear‐wave elastography(2D‐SWE),and venography,highlighting the importance of these techniques in determining the property and stage of the thrombus.In terms of treatment,we underscored the fundamental role of anticoagulant therapy and mentioned the adjuvant effects of vasoactive drugs and heparinoid antithrombotic drugs.We recommended interventional thrombectomy techniques,such as catheter‐directed thrombolysis(CDT),percutaneous mechanical thrombectomy(PMT),and large‐bore catheter manual aspiration(MAT).In this article we cited results from multiple clinical studies,demonstrating the effectiveness and safety of these techniques in the treatment of subacute DVT.Finally,we looked forward to future research directions in the diagnosis and treatment of subacute DVT,including the development of new molecular imaging technologies,the establishment of a correlation model between the degree of thrombus organization and treatment outcomes,the exploration of the effects of anticoagulant combined with vasoactive drugs,and the use of artificial intelligence for prognosis prediction.We emphasized that with the advancement of precision medicine,the diagnosis and treatment of subacute DVT are expected to shift from an empirical model to a stratified management approach based on thrombus biological characteristics,in order to improve patients’long‐term prognosis.
作者
李新庆
潘杰
桑宏飞
LI Xinqing;PAN Jie;SANG Hongfei(Department of Vascular Surgery,Second Affiliated Hospital of Soochow University,Jiangsu Suzhou 215004,China)
出处
《外科理论与实践》
2024年第6期477-480,共4页
Journal of Surgery Concepts & Practice
关键词
亚急性下肢深静脉血栓
抗凝治疗
血栓清除技术
Subacute lower extremity deep vein thrombosis(LEDVT)
Anticoagulant therapy
Thrombectomy technique
