摘要
目的探讨Günther Tulip可回收式腔静脉滤器在下肢深静脉血栓形成介入治疗中的应用效果及操作技术。方法 2007年9月至2008年4月于我院就治的急性下肢深静脉血栓形成患者36例,发病时间1～12h,发病诱因包括术后及骨折后卧床18例、产后5例、无明显诱因13例;合并肺动脉栓塞12例。症状表现为患肢肿胀(患肢大腿周径比健侧大3～10cm)、疼痛、皮肤呈青紫色或苍白,皮温升高或正常,合并肺动脉栓塞者表现为呼吸困难、胸痛、咯血等。分别经股静脉或经右颈内静脉置入Günther Tulip可回收式腔静脉滤器后,均行静脉内置管溶栓治疗。术后45～75d经血管超声及血管造影复查证实下肢静脉及肺动脉内无新鲜或游离血栓后,经右颈内静脉入路行Günther Tulip腔静脉滤器取出术,复查下腔静脉造影。术后给予抗凝、抗炎治疗3～5d。随访4～10个月。结果共置入Günther Tulip可回收式腔静脉滤器36枚,均一次性释放成功,释放过程平均耗时1.5min(0.5～5min),释放过程中滤器弹跳幅度小于2mm,1例滤器置入时倾斜25°,滤器置入后未出现新发生肺动脉栓塞的临床表现。12例患者于术后45～75d行Günther Tulip腔静脉滤器取出术,均一次性回收成功,回收过程耗时4.4min(2～15min),下腔静脉造影复查未见管壁穿孔及破裂征象。其余24例患者未行滤器取出术,随访期间未出现肺动脉栓塞及下腔静脉闭塞的临床表现。结论 Günther Tulip可回收式腔静脉滤器具有释放定位准确、捕获血栓能力较高、可取出时间期限长(溶栓治疗时间窗长)、回收成功率高等优点,在下肢深静脉血栓介入治疗中的临床效果良好,技术操作成功率较高。
Objective To discuss the therapeutic efficacy and manipulation skill of Günther Tulip retrievable inferior vena cava filter in interventional treatment for acute deep venous thrombosis of lower extremity.Methods From September 2007 to April 2008,a total of 36 patients with acute deep venous thrombosis of lower extremity were treated in our hospital.The time of the onset of disease ranged from 1 day to 12 days.The precipitation causes included prolonged lying in bed due to surgery or bone fracture（n = 18） and postpartum（n = 5）,while no obvious precipitation causes could be found in 13 patients.Pulmonary embolism was coexisted in 12 cases.Clinically,the affected limb was swelling and painful,the skin was cyan-purple or pale in color with higher skin temperature.The circumferential length of the affected thigh was 3-10 cm longer than that of normal side.Patients with coexisted pulmonary embolism had the clinical presentation of dyspnea,chest pain,hemoptysis,etc.Günther Tulip retrievable inferior vena cava filter was implanted via femoral venous access or via right internal jugular venous access,which was followed by intravenous transcatheter thrombolysis.Vascular ultrasonography and angiography were performed 45-75 days after the treatment to confirm that there was no fresh or free thrombus in the veins of lower limb or in the pulmonary arteries.When it was confirmed,Günther Tulip retrievable inferior vena cava filter was taken out via right internal jugular venous access,which was followed by inferior venacavography.After the procedure anticoagulation and antibiotic medication were employed for 3-5 days.A follow-up for 4-10 months was made.Results A total of 36 Günther Tulip retrievable inferior vena cava filters were successfully implanted by one procedure,the average time cost for the filter delivery was 1.5 minutes（0.5-5 minutes）.During the delivery procedure,the amplitude of elastic displacement of filter was less than 2 mm.One filter was implanted with a tilt of 25 degrees,and no newly-developed clinical manifestations of pulmonary embolism appeared after filter implant.In twelve patients Günther Tulip filters were successfully retrieved by single manipulation in 45-75 days after filter delivery,and the retrieval procedure took the mean time of 4.4 minutes（2-15 minutes）.Inferior venacavography confirmed that no vascular perforation or rupture occurred.In the remaining 24 patients the filters were kept in inferior vena cava and no clinical symptoms related to pulmonary embolism or inferior vena cava occlusion were observed during the follow-up period.Conclusion Günther Tulip retrievable inferior vena cava filter has many advantages in clinical use.The filter can be accurately placed to the scheduled position,it is very powerful in capturing the thrombus,it can be hold in the inferior vena cava for long time（long time window for thrombolysis therapy） before it is planed to be retrieved,and its retrieval success is very high.Moreover,with high technical successful rate the implantation of Günther Tulip retrievable inferior vena cava filter is very safe and effective for the interventional treatment of acute deep venous thrombosis of lower extremity.
出处
《介入放射学杂志》
CSCD
北大核心
2010年第9期707-711,共5页
Journal of Interventional Radiology
基金
国家十一五科技支撑计划(2007BAI05B04)
关键词
腔静脉
可回收滤器
深静脉血栓形成
效果
inferior vena cava
retrievable filter
deep venous thrombosis
efficacy
