可回收腔静脉滤器的使用探讨

Using retrievable vena cava filter in DVT patients

目的:总结下肢深静脉血栓形成患者植入可回收腔静脉滤器的临床体会。方法:下肢深静脉血栓形成患者36例,单侧32例,双侧4例;男21例,女15例;平均年龄45岁。术前均经血管彩色多普勒超声确诊,并明确栓塞范围、栓尾位置、解剖条件和腔静脉情况。手术在DSA室局麻下进行,经右颈内静脉穿刺植入可回收腔静脉滤器于下腔静脉,捕捉血栓和预防肺血栓栓塞症;监测滤器位置,4周时回收。随访行血管彩色多普勒超声及胸片检查。结果:可回收腔静脉滤器植入全部成功,术后即刻造影,滤器形态及位置佳。可回收腔静脉滤器捕捉血栓患者29例,占80.56%。1例3周后橄榄体及限制性导管滑出,急诊回收滤器。回收术后随访:36例随访3～10个月无肺血栓栓塞症相关症状,后期死亡0例。结论:可回收腔静脉滤器预防肺血栓栓塞症安全有效,下肢深静脉血栓形成患者为预防肺血栓栓塞症植入可回收腔静脉滤器是必要的。

Obiective： To evaluate the clinical effects of retrievable vena cava filter （r-VCF） used in patients with deep venous thrombosis （DVT）. Methods： In 36 cases of DVT, 32 cases presented in single lower extremities and 4 cases in bilateral lower extremities, including 21 male and 15 female with mean age of 45 years. All patients were diagnosed by Color Doppler Flow Imaging （CDFI） to locate the emboli and to make sure the diameter of vena cava. The r-VCF （B.Braun tempofilter II ）were implanted into inferior caval vein （IVC） through right internal jugular vein under local anesthesia in DSA room. Then the position of the r-VCF was monitored during the implantation period and the r-VCF was retrieved after 4 weeks. The follow-up data about CDFI and thoracic X- ray was evaluated. Results： All r-VCF were implanted successfully. Immediate venography after procedure showed the filter was positioned properly. Thrombi was trapped in 29 cases （80.56%）. The silicone olive body and the tethering catheter slid out after 3 weeks in 1 case, and the r-VCF was retrieved safely. All patients were followed for 3 to 10 months. There were no related complications and death. Conclusion： R-VCF is safe, effective and necessary in prevention of pulmonary thromboembolism （PTE） for patients with DVT.