下腔静脉滤器置放术在深静脉血栓-肺栓塞演变中的临床应用

Clinical application of inferior vena cava filter for preventing evolvement of deep venous thrombosis to pulmonary embolism

目的探讨下腔静脉滤器(IVCF)在预防深静脉血栓(DVT)-肺栓塞(PE)演变中的临床应用价值。方法经造影和(或)彩色多普勒超声证实为下肢深静脉广泛血栓30例,其中有肺部临床表现21例,胸部影像学证实19例,DSA显示下腔静脉内血栓6例。溶栓介入治疗前置放IVCF 30例,下腔静脉内血栓形成未放IVCF 1例。置放IVCF后经患肢足背静脉滴注尿激酶或经导管血栓内抽吸、局部溶栓、导丝搅拌增加溶栓接触面积;经非患肢静脉给予抗凝、抗生素治疗。结果本组30例放置5种构型滤器32枚,其中2枚为临时滤器,置入取出均顺利,滤器无移位,术中无并发症。痊愈9例,有效14例,改善6例,无效1例。因没有及时置入IVCF进行溶栓治疗,深静脉血栓导致下腔静脉血栓6例,后置入IVCF 5例疗效良好,未放IVCF 1例,12天后因肺栓塞死亡。结论下腔静脉滤器对预防深静脉血栓向肺栓塞演变具有一定价值,其置放术安全可靠,便于临床及时溶栓抗凝治疗,但其应用价值需进行综合评价和进一步探讨。

Objective To explore the clinical application and value of inferior vena cava filter （IVCF） for preventing evolvement of deep venous thrombosis （DVT） with pulmonary embolism （PE）. Methods From Dec 1998 to Dec 2005, 30 patients （aged from 36 to 78 years old） of lower limb deep venous thrombosis （DVT） were proved by venography and/or color Doppler ultrasonography in our hospital. The pulmonary symptoms were manifested in 21 cases, abnormal imaging sign of chest were found in 19 cases, thrombosis of inferior vena cava （IVC） were found by DSA in 6 cases. 30 patients underwent preventive IVCF placement for thrombolysis by urokinase. Antegrade infusion of urokinase was performed via the dorsolis pedis vein of the involved lower limb, pumping local thrombus via catheter. All the patients were closely monitored by clinic and laboratory. The therapeutic effects were divided into four scales： recovery, efficiency, improvement, inefficacy. Results A total of 32 IVC filter （5 kinds of model： permanence, temporary） were successfully deployed in 30 cases without disposition and migration. Recovery： disappearance of the venous thrombosis （n= 9）; efficiency： the diameter of lumen was larger than 70% proved by venography and color Doppler ultrasonography （n= 14） ; improvement： the diameter of lumen was smaller than 70%（n=6）; and inefficacy （n= 1）. One patient with thrombosis of IVC died after 12 days of finding thrombosis of DVT. Conclusion IVC filter is valuable, effective and safe method for preventing the evolvement from DVT to PE, however, its value in practice still requires further study and synthetic evaluation.