一种腔静脉滤器回收方法的研究

Animal experimental study of a vena cava filter retrieval method

目的探讨一款腔静脉滤器回收钳夹的有效性和安全性。方法在3只普通健康家猪下腔静脉内进行临床常用的四款滤器OptEase、Option、Denali、Aegisy的释放,通过钳夹(67次)、导丝成环(Wire Loop)(40次)和正常圈套(60次)方法进行滤器回收,记录回收时间,术中射线量和出血量并做单因素方差分析。结果使用滤器回收钳夹对四款滤器进行了67次回收,四款滤器均能被钳夹有效夹持并顺利取出体外,在回收时间,射线量和出血量方面差异并无统计学意义(P>0.05)。回收时间分别为(17.65±6.93)、(13.65±6.43)、(17.90±6.03)、(15.29±6.32)min(F=0.479,P>0.05);射线量分别为(327.50±126.00)、(262.90±144.60)、(343.50±125.60)、(298.90±143.80)mGy(K-W=6.009,P>0.05);出血量分别为(36.25±14.31)、(32.50±20.88)、(41.80±16.71)、(32.14±12.72)ml(K-W=5.443,P>0.05)。使用Wire Loop和正常圈套方法分别进行40次和60次回收,记录相应数据,与钳夹回收对比,钳夹法在回收时间,射线量和出血量方面均优于Wire Loop法,差异有统计学意义(P<0.01),与正常圈套法比较各方面数据仍然存在差距(P<0.01)。钳夹法回收时间低于Wire Loop法[(16.28±6.59)min比(27.58±8.81)min]但高于正常圈套法[(16.28±6.59)min比(10.12±3.37)min,K-W=80.280,P<0.01];钳夹法射线量低于Wire Loop法[(310.00±134.60)mGy比(570.40±208.10)mGy]但高于正常圈套法[(310.00±134.60)mGy比(214.20±76.81)mGy,K-W=80.280,P<0.01];钳夹法出血量低于Wire Loop法[(36.36±17.17)ml比(58.28±18.10)ml],但高于正常圈套法[(36.36±17.17)ml比(13.08±6.45)ml,K-W=80.280,P<0.01]。结论腔静脉滤器回收钳夹可以适用于滤器倾斜,回收钩贴壁、通过正常圈套方法无法回收的情况,具有较高的临床应用价值。

Objective To investigate the effectiveness and safety of a vena cava filter retrieval clamp through animal experiments.Methods Four commonly used filters OptEase,Option,Denali and Aegisy were released in the inferior vena cava of three ordinary healthy domestic pigs.Filter retrieval was performed by filter retrieval clamp(67times),Wire Loop(40times)and normal snare(60times)methods.The retrieval time,intraoperative radiation dose,and blood loss were recorded,and one-way ANOVA among the three groups was performed.Results Four filters were retrieved 67 times with the clamp.All filters could be effectively clamped and removed successfully.There was no significant difference in retrieval time,radiation dose,and blood loss(P>0.05),the retrieval time were(17.65±6.93),(13.65±6.43),(17.90±6.03)and(15.29±6.32)min,respectively,F=0.479,P>0.05;The radiation dose were(327.50±126.00),(262.90±144.60),(343.50±125.60)and(298.90±143.80)mGy,respectively,K-W=6.009,P>0.05;The blood loss was(36.25±14.31),(32.50±20.88),(41.80±16.71)and(32.14±12.72)ml,respectively,K-W=5.443,P>0.05.The Wire Loop and normal snare methods were used for 40 and 60 retrievals,respectively,and the corresponding data were recorded.Compared with clamp retrieval,clamp retrieval was better than the Wire Loop method in terms of retrieval time,radiation amount,and blood loss,and the difference was statistically significant(P<0.01).There were still gaps in various data compared with the normal snare method,and the difference was statistically significant(P<0.01).The retrieval time of clamp method was lower than that of wire Loop method[(16.28±6.59)min vs.(27.58±8.81)min]but higher than that of normal snare method[(16.28±6.59)min vs.(10.12±3.37)min,K-W=80.280,P<0.01];The radiation dose of clamp method was lower than that of wire Loop method[(310.00±134.60)mGy vs.(570.40±208.10)mGy]but higher than that of normal snare method[(310.00±134.60)mGy vs.(214.20±76.81)mGy,K-W=80.280,P<0.01];The amount of blood loss by clamp method was lower than that of wire Loop method[(36.36±17.17)ml vs.(58.28±18.10)ml]but higher than that of normal snare method[(36.36±17.17)ml vs.(13.08±6.45)ml,K-W=80.280,P<0.01].Conclusion The vena cava filter retrieval clamp can be used in cases where the filter is tilted,the retrieval hook is attached to the wall,and the normal snare method fails,which has high clinical application value,but needs further improvement and optimization.