非永久型下腔静脉滤器预防肺栓塞的安全性和有效性

Safety and Efficiency of Non-permanent Inferior Vena Cava Filters in Preventing Pulmonary Embolism

目的评价非永久型下腔静脉滤器预防下肢深静脉血栓（DVT）脱落导致肺栓塞（PE）的安全性和有效性。方法回顾性分析2003年9月-2006年6月在我院收治的12例使用非永久型滤器的DVT患者的临床资料。结果12例患者中，10例采用临时型滤器，2例采用可回收滤器，所有植入手术均获得成功，无严重并发症。10例临时滤器患者中，9例在术后4周成功取出滤器，1例出现滤器周围巨大血栓，继续给予抗凝治疗于术后12周取出。2例可回收滤器中，1例于术后2周成功取出；1例因捕捉巨大血栓，将滤器留置体内。12例患者中，滤器抓捕血栓6例（50％），其中2例（16．6％）血栓〉2cm，1例（8．3％）〉1cm，3例（25％）〈1cm。10例患者在术前进行了PE影像学检查，其中5例有PE；8例患者在术后6个月行PE检查，其中4例有小面积PE，但较治疗前均已有显著改善。12例患者均进行了有效随访，随访时间3个月-2年，其中10例患者随访时间〉6个月，1例患者在术后4个月因恶性肿瘤死亡，1例临时滤器在术后出现下腔静脉梗阻，5例PE患者均有缓解。结论非永久型滤器可有效预防PE发生，但在某些技术细节上还需进一步研究和改善。

Objective To assess the effectiveness and safety of non-permanent filter in preventing pulmonary embolism （PE） caused by deep venous thrombolism （DVT）. Methods The clinical data of 12 patients who were implanted with non-permanent filter for documented deep venous thrombolism in Peking Union Medical College Hospital from September 2003 to June 2006 were retrospectively analized. Results Among these 12 patients, 10 were implanted with temporary filters, and 2 with retrievable filters. All the 12 operations were successful without major complications. In the 10 patients who received temporary filters, filters were smoothly removed after 4 weeks in 9 patients, while one patient was further treated with anticoagulation therapy for 12 weeks because large emboluses were entrapped ters, filter were smoothly removed 2 weeks later in one by filter. In the 2 patients who received retrievable filpatient; however, in another patient, the filter was left inside because large emboluses were entrapped by filter. In all the 12 patients, emboluses were entrapped in 6 filters （50%） , in which the emboluses were larger than 2 cm in 2 patients, larger than 1 cm but less than 2 cm in 1 patient, and less than 1 cm in 3 patients. PE scanning was performed in 10 patients before primary implantation, and PE was found in 5 patients. PE scanning was performed in 8 patients 6 months after implantation, and minor PE was found in 4 patients, whose symptoms and affected pulmonary artery were obviously improved. All patients received regular follow-up （ ranged from 3 months to 2 years）, 1 patient died of malignant tumor 4 months after operation, 1 patient suffered inferior vena cava occlusion due to large embolus entrapped by the temporary filter, and 1 patient experienced the recurrence of symptomatic DVT. Symptoms were improved in all the 5 patients with PE. Conclusions Non-permanent filter can safely and effectively protect patients from PE. More standardized criteria for placement and protocols to ensure timely removal should be developed and implemented.