彩色多普勒超声引导下经右颈内静脉置入下腔静脉滤器的临床应用

Clinical value of inferior vena caval filter insertion under color Doppler flow imaging guidance through the right internal jugular vein

目的探讨下肢深静脉血栓形成（DVT）的患者,在彩色多普勒超声（CDFI）引导下将下腔静脉滤器（IVCF）从右颈内静脉置入下腔静脉预防肺栓塞的可行性、安全性和临床应用价值。方法对38例经临床和CDFI检查证实为下肢深静脉血栓的患者,经右颈内静脉置入IVCF,定期超声监测IVCF的形态与位置。临时性IVCF在放置32~45 d后在超声引导下经右颈内静脉取出。随访观察有无PE及滤器并发症。结果 38例患者术前均经CDFI检查,右颈内静脉、下腔静脉、髂总静脉分叉、双侧肾静脉开口位置显示均清晰,所有静脉无变异,无血栓,显示率100%。在CDFI引导下,经右颈内静脉置入临时性IVCF 23个,永久性IVCF 15个,技术成功率100%。术后CDFI和X线腹部平片均证实滤器置入位置正确,展开完全。23个临时性IVCF 32~45 d后均经右颈内静脉取出。随访栓子捕获率36.5%,滤器无错位、移位、断裂,患者没有出现腔静脉穿孔、肺栓塞等并发症。结论CDFI引导经右颈内静脉置入IVCF术是一种安全、可靠的方法;相对于X线引导,CDFI引导IVCF置入术具有简便、易行、无放射线、费用低廉等优点。

Objective To explore the efficacy and feasibility of color Doppler flow imaging （CDFI）-guided inferior vena caval filter （WCF） insertion through the right internal jugular vein for prevention of pulmonary embolism in patients with deep venous thrombosis （DVT）. Methods Thirty-eight patients with lower extremity DVT confirmed by clinical and CDFI examinations underwent WCF insertion through the right internal jugular vein under guidance of CDFI for prevention of pulmonary embolism. The shape and position of WCF were monitored by CDFI regularly. After 32 to 45 days, the retrievable filters were removed under CDFI guidance via the right internal jugular vein. All patients were followed up to monitor the occurrence of filter complications and pulmonary embolism PE. Results Preoperative CDFI clearly displayed the locations of the right internal jugular vein, inferior vena caval （WC）, bifurcation of the common iliac vein, and the bilateral renal veins in all the 38 patients. All the veins were free of anatomical variations or embolism. Under CDFI guidance, 23 retrievable WCF and 15 permanent WCF were placed without technical difficulty via the right internal jugular vein. Follow-up examination with CDFI and abdominal plain X-ray film showed that all the filters were placed in right positions with complete opening. The 23 retrievable filters were retrieved via the right internal jugular vein after 32-45 days. IVCF captured venous emboli in 14 cases （36.5%）. None of the patients had filter displacement, tilting, or fracture or showed WC perforation or the occurrence of pulmonary embolism. Conclusion CDFI-guided IVCF insertion via the jugular vein is safe and feasible. Compared with X-ray guidance, CDFI guidance is convenient and substantially reduces the procedural cost and avoids the risk of radiation exposure.