• 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院血管外科（北京 100029）;

目的 　探討下肢深靜脈血栓急性期手術(shù)取栓的療效和安全性。
方法 　計(jì)算機(jī)檢索MEDLINE（1966～2006.6）、 EMbase（1984～2006.6）、Cochrane圖書(shū)館（2006年第2期）、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（1989～2006.6）、中文生物醫(yī)學(xué)期刊數(shù)據(jù)庫(kù)（1994～2006.6）和中國(guó)醫(yī)學(xué)學(xué)術(shù)會(huì)議論文數(shù)據(jù)庫(kù)（1994～1999），手檢國(guó)內(nèi)《血管外科會(huì)議匯編》（1991～2006.6）和國(guó)內(nèi)《血管外科》雜志（2000～2006.6），納入手術(shù)取栓與標(biāo)準(zhǔn)抗凝治療比較的隨機(jī)對(duì)照試驗(yàn)。由兩名研究者獨(dú)立進(jìn)行文獻(xiàn)質(zhì)量評(píng)價(jià)和數(shù)據(jù)提取，并按Cochrane協(xié)作網(wǎng)提供的方法對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)和結(jié)果分析。
結(jié)果 　共檢索到相關(guān)文獻(xiàn)8篇，其中6篇符合納入標(biāo)準(zhǔn)。手術(shù)取栓組6個(gè)月靜脈完全通暢率高于抗凝治療組 [OR=7.26, 95%CI (2.40, 21.94)]。兩組5年靜脈通暢率差異無(wú)統(tǒng)計(jì)學(xué)意義 [OR=2.59, 95%CI (0.88, 7.67)]。手術(shù)取栓組6個(gè)月深靜脈血栓形成后綜合征（PTS）的發(fā)生率 [OR=0.11, 95%CI (0.59, 1.59)] 和5年P(guān)TS發(fā)生率 [OR=0.18, 95%CI (0.06, 0.60)] 均低于抗凝組，但兩組10年P(guān)TS發(fā)生率和大部分瓣膜靜脈功能測(cè)定指標(biāo)無(wú)差異。兩組肺栓塞的發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義 [OR=1.40, 95%CI (0.39, 4.97)]。
結(jié)論 　對(duì)于爭(zhēng)性下肢深靜脈血栓形成患者，手術(shù)取栓僅能促進(jìn)其近期靜脈瓣膜功能恢復(fù)和通暢程度，而對(duì)改善通暢率作用不顯著。目前缺乏足夠的證據(jù)證實(shí)手術(shù)遠(yuǎn)期療效具有優(yōu)勢(shì)。手術(shù)取栓具有較好的安全性。鑒于本評(píng)價(jià)納入的試驗(yàn)樣本量小，質(zhì)量不高，且多數(shù)發(fā)表年限較早，降低了結(jié)論的可靠性, 亟需大樣本試驗(yàn)證實(shí)其療效。

引用本文： 羅小云,吳慶華,寇 鐳. 手術(shù)取栓治療急性下肢深靜脈血栓形成的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2006, 06(11): 815-819. doi: 復(fù)制

1. 董國(guó)祥. 急性下肢深靜脈血栓形成的手術(shù)治療. 中國(guó)實(shí)用外科雜志, 2003; 23(4): 210~211.
2. 黃曉鐘, 王鵬, 張皓, 等. 下肢深靜脈血栓形成165例的治療分析. 中華普通外科雜志, 2002; 17(11): 666~667.
3. 何宇東, 周修靜. 靜脈血栓切除術(shù)對(duì)急性深靜脈血栓形成的意義探討. 現(xiàn)代臨床普通外科. 1997: 2(3): 145~148.
4. 駱?biāo)奢x, 龔時(shí)文, 閔軍, 等. 早期急診手術(shù)取栓治療下肢深靜脈血栓形成29例報(bào)告. 中國(guó)醫(yī)師雜志, 2005; 7(10): 1363~1364.
5. 段鵬飛, 錢(qián)愛(ài)民, 桑宏飛, 等. 介入聯(lián)合手術(shù)治療急性下肢深靜脈血栓形成. 解剖與臨床, 2004; 9(2): 91~93.
6. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest, 2004; 126(3): 401S–418S.
7. Juhan CM, Alimi YS, Barthelemy PJ, et al. Late results of iliofemoral venous thrombectomy. J Vasc Surg, 1997; 25(3): 417–422.
8. Dong GX. Surgical treatment of acute deep venous thrombosis of lower extremities. Chinese Journal of Practical Surgery, 2003; 23(4): 210–211.
9. Huang XZ, Wang P, Zhang H, et al. Treatment of lower extremity deep venous thrombosis in 165 patient. Chinese Journal of General Surgery, 2002; 17(11): 666–667.
10. Plate G, Einarsson E, Ohlin P, et al. Thrombectomy with temporary arteriovenous fistula: the treatment of choice in acute iliofemoral venous thrombosis. J Vasc Surg, 1984; 1(6): 867–876.
11. Plate G, Akesson H, Einarsson E, et al. Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula. Eur J Vasc Surg, 1990; 4(5): 483–489.
12. Plate G, Eklof B, Norgren L, et al. Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg, 1997; 14(5): 367–374.
13. Plate G, Ohlin P, Einarsson E, et al. Pulmonary embolism in acute iliofemoral venous thrombosis. Br J Surg, 1985; 72: 912–915.
14. He YD, Zhou XJ. Significance of thrombectomy for acute deep venous thrombosis. Modern Clinics in General Surgery, 1997: 2(3): 145–148.
15. Luo SH, Gong SW, MIN J, et al. Report on 29 cases of early thrombectomy for deep venous thrombosis of lower extremities. Journal of Chinese Physician, 2005; 107(10): 1363–1364.
16. Blatter W, Heller G, Largiade G, et al. Combined regional thrombolysis and surgical thrombectomy for treatment of iliofemoral vein thrombosis. J Vasc Surg, 2004; 40: 620–625.
17. Duan PF, Qian AM, Sang HF, et al. Intervention and surgical therapy of acute lower extremity deep vein thrombosis. Anatomy and Clinics, 2004; 9(2): 91–93.
  1. 1. 董國(guó)祥. 急性下肢深靜脈血栓形成的手術(shù)治療. 中國(guó)實(shí)用外科雜志, 2003; 23(4): 210~211.
  2. 2. 黃曉鐘, 王鵬, 張皓, 等. 下肢深靜脈血栓形成165例的治療分析. 中華普通外科雜志, 2002; 17(11): 666~667.
  3. 3. 何宇東, 周修靜. 靜脈血栓切除術(shù)對(duì)急性深靜脈血栓形成的意義探討. 現(xiàn)代臨床普通外科. 1997: 2(3): 145~148.
  4. 4. 駱?biāo)奢x, 龔時(shí)文, 閔軍, 等. 早期急診手術(shù)取栓治療下肢深靜脈血栓形成29例報(bào)告. 中國(guó)醫(yī)師雜志, 2005; 7(10): 1363~1364.
  5. 5. 段鵬飛, 錢(qián)愛(ài)民, 桑宏飛, 等. 介入聯(lián)合手術(shù)治療急性下肢深靜脈血栓形成. 解剖與臨床, 2004; 9(2): 91~93.
  6. 6. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease. Chest, 2004; 126(3): 401S–418S.
  7. 7. Juhan CM, Alimi YS, Barthelemy PJ, et al. Late results of iliofemoral venous thrombectomy. J Vasc Surg, 1997; 25(3): 417–422.
  8. 8. Dong GX. Surgical treatment of acute deep venous thrombosis of lower extremities. Chinese Journal of Practical Surgery, 2003; 23(4): 210–211.
  9. 9. Huang XZ, Wang P, Zhang H, et al. Treatment of lower extremity deep venous thrombosis in 165 patient. Chinese Journal of General Surgery, 2002; 17(11): 666–667.
  10. 10. Plate G, Einarsson E, Ohlin P, et al. Thrombectomy with temporary arteriovenous fistula: the treatment of choice in acute iliofemoral venous thrombosis. J Vasc Surg, 1984; 1(6): 867–876.
  11. 11. Plate G, Akesson H, Einarsson E, et al. Long-term results of venous thrombectomy combined with a temporary arterio-venous fistula. Eur J Vasc Surg, 1990; 4(5): 483–489.
  12. 12. Plate G, Eklof B, Norgren L, et al. Venous thrombectomy for iliofemoral vein thrombosis--10-year results of a prospective randomised study. Eur J Vasc Endovasc Surg, 1997; 14(5): 367–374.
  13. 13. Plate G, Ohlin P, Einarsson E, et al. Pulmonary embolism in acute iliofemoral venous thrombosis. Br J Surg, 1985; 72: 912–915.
  14. 14. He YD, Zhou XJ. Significance of thrombectomy for acute deep venous thrombosis. Modern Clinics in General Surgery, 1997: 2(3): 145–148.
  15. 15. Luo SH, Gong SW, MIN J, et al. Report on 29 cases of early thrombectomy for deep venous thrombosis of lower extremities. Journal of Chinese Physician, 2005; 107(10): 1363–1364.
  16. 16. Blatter W, Heller G, Largiade G, et al. Combined regional thrombolysis and surgical thrombectomy for treatment of iliofemoral vein thrombosis. J Vasc Surg, 2004; 40: 620–625.
  17. 17. Duan PF, Qian AM, Sang HF, et al. Intervention and surgical therapy of acute lower extremity deep vein thrombosis. Anatomy and Clinics, 2004; 9(2): 91–93.