对比OptEase和Tulip两种滤器在介入治疗深静脉血栓形成中的价值

Comparison on the value of OptEase filter and Tulip filter in endovascular therapy of deep venous thrombosis

目的通过对OptEase和Tulip两种可回收滤器置入患者进行临床对比观察,评价两种滤器在预防肺栓塞（PE）的效率、可回收性及并发症等方面的差异。方法收集123例诊断明确的深静脉血栓形成（DVT）患者,按照置入滤器的种类分为OptEase滤器组及Tulip滤器组,随访13~46个月。滤器置入术后3、7天摄腹平片及静脉造影观察滤器形态、位置及附着血栓情况。术后1、3、6、12、24、36个月摄腹平片,进行下腔静脉及下肢静脉超声检查对有条件者加行静脉造影。如随访期间出现胸痛、呼吸困难等可疑PE症状,则立即行3DCT检查,明确是否发生PE。对两组各并发症发生率行χ2检验。结果两组患者滤器放置成功率100%,无术中和近期并发症。住院及随访期内均未发生新发PE,未出现滤器断裂、穿透血管壁的病例。OptEase滤器组回收成功率90.00%。Tulip滤器组回收成功率100%。未进行回收患者中,OptEase滤器组41例,3例发生下肢静脉血栓（3/41,7.32%）,1例发生下腔静脉血栓（1/41,2.44%）。Tulip滤器组43例,2例发生滤器倾斜（2/43,4.65%）,3例发生下肢静脉血栓（3/43,6.98%）,1例下腔静脉血栓（1/43,2.33%）。两组各并发症发生率差异均无统计学意义（P均〉0.05）。结论两种下腔静脉滤器在放置或回收成功、能预防PE的效率、并发症发生率方面并无明显差别。

Objective To compare the efficiency of preventing pulmonary embolism（PE）,retrieval and complications between OptEase filter and Tulip filter by case-control studying in deep venous thrombosis（DVT） patients.Methods Totally 123 patients diagnosed as DVT were divided into Tulip filter group and OptEase filter group according to the type of filters,and the follow-up period was from 13—46 months.Radiography and angiography was performed 3 and 7 days after operation to examine the shape,location of filters and thrombosis in inferior vena cava or lower extremity vein.Radiography was performed 1,3,6,12,24 and 36 months after operation,and ultrasonography of inferior vena cava and lower extremity vein was executed.Venography was made if the patients agreed.If chest pain,shortness of breath,dyspnea and other symptoms of PE appeared in follow-up period,3DCT was performed immediately to detect PE.Chi-square test was used to compare the incidence rate of complications between two groups.Results Technical success rate was 100% in the filter placement in two groups,and no intraoperative complications nor near-term complications appeared.No PE occurred,no filter fracture and penetration of the vessel wall were found during hospitalization and follow-up periods.The success rate of retrieval was 90.00% in OptEase filter group,and was 100% in Tulip filter group.Among the unretrieved patients,41 were in OptEase filter group,including DVT in 3 patients（3/41,7.32%） and inferior vena cava thrombosis in 1 patient（1/41,2.44%）.Other 43 patients were in Tulip filter group,including tilt in 2 patients（2/43,4.65%）,DVT in 3 patients（3/43,6.98%） and inferior vena cava thrombosis in 1 patient（1/43,2.33%）.No statistical difference was found between the incidence rate of complications in two groups（both P0.05）.Conclusion There is no difference between OptEase filter and Tulip filter in the success rate of placement and retrieval,the efficiency of preventing pulmonary or the incidence of complications.