下腔静脉滤器临床应用单中心中-长期疗效观察

Mid-and long-term results of inferior vena cava filter placement in a single-center

目的 评价下腔静脉滤器（vena cava filter,VCF）植入的中-长期临床疗效与并发症.方法 回顾性分析1998年8月至2012年8月首都医科大学附属北京世纪坛医院行VCF植入术272例患者,按照无抗凝、常规抗凝治疗、抗凝结合手术取栓或局部导管溶栓加支架术等分为3组,A组（19例）、B组（112例）、C组（141例）,分别对患者的腔静脉通畅率、肺动脉栓塞（pulmonary embolism,PE）及并发症的发生情况进行分析、总结.结果 本组患者手术均获成功,围手术期无严重并发症及症状性PE发生.随访时间3个月至9年,平均（3.8±1.2）年.远期新发PE 3例;深静脉血栓形成（deep vein thrombosis,DVT）复发29例;血栓后综合征（post thrombosis syndrome,PTS）40例;症状性下腔静脉血栓形成19例,完全闭塞9例.腔静脉通畅情况：3年以上累计通畅率为88.64％;其中A组84.2％,B组96.43％,C组98.58％,B、C组均好于A组;DVT发生在左下肢者腔静脉通畅率（98.65％）,较右下肢（90.32％）及双下肢（83.33％）患者为高.结论 VCF预防PE安全、有效,同时作为综合性治疗的重要辅助手段提高了静脉血栓栓塞症的疗效.VCF术后规范抗凝治疗可提高远期腔静脉通畅率.

Objective To evaluate the mid-and long-term clinical curative effect and complications after inferior vena cava filter （VCF） implantation.Methods Clinical data of 272 patients from August 1998 to August 2012 in our hospital were retrospectively reviewed and patients were divided into group A （19 cases） in which no anticoagulant was given,group B （112 cases） receiving conventional anticoagulant therapy,and group C （141 cases） managed with anticoagulation plus embolectomy or catheter directed thrombolysis and stent implantation.The caval patency rate,PE events and complications were analyzed.Results Filter implantation was successful in all the 272 cases.There was no procedure-related serious complications and symptomatic pulmonary embolism （PE）.Patients were followed-up from 3 months to 9 years,with an average of 3.8 ± 1.2 years.The number of new-onset PE was 3,recurrent DVT was 29,and PTS was 40.There were 19 patients presenting inferior vena cava thrombosis,with complete IVC occlusion in 9 cases.3 year patency rate was 88.64% ; Patency rate of vena cava respectively was：84.2% in group A,96.43% in group B,98.58% in group C.Vena cava patency rate was higher with DVT originating in the left lower limb （98.65%） than that in the right （90.32%） and bilateral limbs （83.33%）.Conclusions VCF can prevent PE safely and effectively.It helps to establish a comprehensive treatment to improve the prognosis of VTE.