应用指引导管辅助回收疑难贴壁下腔静脉滤器42例分析

Guiding catheter assisted recovery of difficult and adherent inferior vena cava filter: An analysis of 42 cases

目的探讨应用指引导管辅助回收疑难贴壁下腔静脉滤器的方法及技巧。方法回顾性分析2009年7月至2016年7月沧州市中心医院普通外一科下腔静脉滤器(Aegisy滤器)回收手术中造影发现滤器回收钩贴壁的42例病人临床资料。结果术中应用7-F多功能(MPA)或7-F"曲棍球棒式"(HS)指引导管辅助改良式拨撬法进行滤器回收。42例手术均取得成功。回收滤器均结构完整、无折断,2例拨撬处轻微变形,滤器取出后行下腔静脉造影均未发现造影剂滞留或外渗。手术时间为28~52 min,平均用时37 min,未明显增加手术时间及费用。随访2~24个月,无相关并发症发生。结论应用指引导管辅助改良式拨撬法可以显著提高回收钩贴壁的下腔静脉滤器回收成功率,使疑难性下腔静脉滤器取出变得既简单又安全,具有一定的临床应用价值。

Objective To explore the methods and techniques of recovery the difficult and adherent inferior vena cava filter by applying guiding catheter. Methods A total of 42 cases with its refractory hook being affixed to the venous wall by intraoperative angiography who admitted inferior vena cava filter （Aegisy filter） recovery operation in First Department of General Surgery, Cangzhou Central Hospital from July 2009 to July 2016 were analyzed retrospectively. Results All the cases successfully used MPA or HS guide catheter assisted method for the recovery of filters. The structure of all the being recycled filters were complete, and 2 cases were deformed slightly. After removed the inferior vena cava filter, contrast agent was not be found stranded or extravasation by angiography. The operation time was 28 to 52 min, with an average of 37 min, did not significantly increase the operation time and cost. After being followed up for 2 to 24 months, no related complication occurred. Conclusion For the difficult and adherent inferior vena cava filter, using guiding catheter can improve the recycling success rate with certain clinical value.