置管溶栓联合下腔静脉滤器置入治疗下腔静脉漂浮血栓

Therapeutic Effect of Catheter Thrombolysis Combined with Inferior Vena Cava Filter Placement in Treatment of Floating Inferior Vena Cava Thrombus

目的评估置管溶栓联合下腔静脉滤器置入在下腔静脉漂浮血栓治疗中的效果。方法收集2013年7月至2014年11月期间昆明医科大学第四附属医院云南省血管外科中心收治的下肢深静脉血栓形成并发下腔静脉漂浮血栓患者16例,经颈内静脉入路置入下腔静脉滤器,经一侧小隐静脉入路行下腔静脉置管溶栓,尿激酶用量（60~80）×10~4 U/d。结果经置管溶栓联合下腔静脉滤器置入治疗后,13例患者下腔静脉漂浮血栓消失,回收的滤器上可见有少量的血栓黏附,下肢肿胀情况缓解,下腔静脉可达有效开通标准;2例下腔静脉漂浮血栓与下腔静脉管腔粘连,造成管腔狭窄,滤器未予回收;1例患者下腔静脉漂浮血栓消失,下肢肿胀情况略有缓解,滤器上可见大量血栓黏附而未予回收。所有患者在出院时下肢肿胀、疼痛等临床症状均缓解,行肺动脉CT示未发生明显肺动脉栓塞征象。对14例患者随访6个月结果见下腔静脉血流通畅,下肢肿胀等情况未加重,复查肺动脉CT未见肺动脉栓塞征象。结论从本组有限的数据初步得出,置管溶栓联合下腔静脉滤器置入在下肢深静脉血栓形成并发下腔静脉漂浮血栓治疗中的疗效可靠,安全性高。

Objective To assess the therapeutic effect of catheter thrombolysis combined with inferior vena cava（IVC） filter placement in treatment of deep venous thrombosis（DVT） complicated with floating IVC thrombus. Methods The clinical data of 16 patients with DVT complicated with floating IVC thrombus from July 2013 to November 2014 in this hospital were collected. These patients were treated with the catheter thrombolysis combined with IVC filter placement, the IVC filter was placed via jugular vein, the catheter thrombolysis was performed by the side of the small saphenous vein, the amount of urokinase was（60-80） ×10^4 U/d. Results 1 The floating IVC thrombi of 13 patients were disappeared following catheter thrombolysis combined with IVC filter placement therapy, a small amount of visible thrombi were adhered on the recycled IVC filter, the lower limb swelling was relieved, the IVC could effectively open. 2 The IVC filters of 2 patients could not be recycled due to the adhesion of floating IVC thrombus and lumen of IVC resulting in luminal stenosis. 3 The floating IVC thrombus of 1 patient was disappeared, the IVC filter could not be recycled due to a large of thrombi adhered on the IVC filter. The lower limb swelling was slowly relieved. The complications such as severe pulmonary embolism didn＇t happen in all the patients during treatment and following-up. Conclusion The limited data preliminarily shows that it is an effective and safe method by catheter thrombolysis combined with IVC filter placement in treatment of DVT complicated with floating IVC thrombus.