摘要
背景与目的:下腔静脉(IVC)血栓形成常继发于IVC滤器置入术后,急性期主要表现为肢体肿胀和肺栓塞(PE),慢性期表现为IVC狭窄、闭塞及深静脉血栓后综合征,因此临床上推荐早期清除急性IVC血栓,减少并发症发生。AngioJet目前已广泛应用于清除急性下肢深静脉血栓,但对急性IVC血栓清除的方法及清除效果研究极少。本文旨在探讨AngioJet血栓清除装置治疗急性IVC血栓形成的有效性和安全性。方法:回顾性分析2020年7月—2021年6月北京积水潭医院血管外科行AngioJet治疗的58例急性IVC血栓患者临床资料,评估手术安全性、PE发生率、血栓清除效果、滤器取出率以及住院时间和血栓治疗费用增加。结果:58例患者均放置了可回收型滤器,术后56例(96.6%)成功取出,2例(3.4%)3个月后失访未取出。行AngioJet治疗后,III级清除10例(17.2%),II级清除34例(58.6%),I级清除14例(24.1%);联合使用导管吸栓或导管溶栓后(CDT)血栓III级清除14例(24.1%),II级清除36例(62.1%),I级清除8例(13.8%);2例(3.4%)发生IVC阻塞,3个月随访通畅率96.6%;术前存在PE 16例(27.6%),术后出现PE或PE加重2例(3.4%),其余患者无变化或PE减轻,手术前后PE情况前后差异无统计学意义(P>0.05);患者术后肝肾功能指标升高,但均未达到急性肝损伤和肾损伤诊断标准。单纯应用AngioJet共22例(37.9%),术后住院时间增加(1.45±0.51)d,增加医疗费用(27248±78)元;AngioJet联合导管吸栓和(或)CDT共36例(62.1%),术后住院时间增加(2.22±1.22)d,增加医疗费用(30607±1134)元,差异有统计学意义(均P<0.05)。结论:AngioJet清除急性IVC血栓治疗安全有效,未明显增加患者症状性PE风险,使用导管吸栓和CDT导管溶栓等治疗可增加血栓清除效果,但会延长术后住院时间并增加血栓清除相关医疗费用。
Background and Aims: Inferior vena cava(IVC) thrombosis is often secondary to IVC filter implantation. The acute phase mainly manifests as limb swelling and pulmonary embolism(PE), and the chronic phase manifests as IVC stenosis, occlusion and post-thrombotic syndrome. Early removal of acute IVC thrombosis is clinically recommended to reduce complications. Angio Jet has been widely used for removing acute lower extremity deep venous thrombosis, but there are few studies on the method and effect of acute IVC thrombus removal. Therefore, this study was conducted to investigate the efficacy and safety of the Angio Jet thrombectomy device in the treatment of acute IVC thrombosis.Methods: The clinical data of 58 patients with acute IVC thrombosis undergoing Angio Jet treatment in the Department of Vascular Surgery of Beijing Jishuitan Hospital from July 2020 to June 2021 were retrospectively analyzed. The surgical safety, incidence of PE, efficacy of thrombus removal and rate of filter removal as well as the increase in postoperative hospital stay and cost for thrombus treatment were evaluated.Results: All the 58 patients had retrievable filters implantation, of whom, the filters were successfully removed in 56 cases(96.6%), and 2 cases(3.4%) were lost to follow-up 3 months later without filter removal. After Angio Jet treatment, 10 cases(17.2%) had grade Ⅲ thrombus clearance, 34 cases(58.6%)had grade Ⅱ clearance, and 14 cases(24.1%) had grade Ⅰ clearance;after combination of catheter aspiration or catheter-directed thrombolysis(CDT), 14 cases(24.1%) had grade Ⅲ clearance, 36 cases(62.1%) had grade Ⅱ clearance, and 8 cases(13.8%) had grade Ⅰ clearance. During the three-month follow-up, 2 cases(3.4%) developed IVC occlusion, and the venous patency rate was 96.6%. There were16 patients(27.6%) with PE before operation, PE symptoms occurred or the PE symptoms became exacerbated in 2 cases(3.4%) after operation, and remained unchanged or were relieved in the other cases. The difference in symptoms of PE showed no statistical significance before and after operation(P>0.05). The liver and renal function parameters of the patients were increased after operation, but all of them did not reach the diagnostic criteria for acute liver injury and kidney injury. A total of 22 patients(37.9%) were treated with Angio Jet alone, their postoperative hospital stay was increased by(1.45±0.51) d, and medical cost was increased by(27 248±78) yuan;a total of 36 patients were treated with Angio Jet combined with catheter thrombectomy and(or) CDT, their postoperative hospital stay increased by(2.22±1.22) d, and the increase in medical expenses was(30 607±1 134) yuan, and the difference had statistical significance(both P<0.05).Conclusion: Angio Jet thrombectomy is safe and effective for removal of acute IVC thrombus without increasing the risk of symptomatic PE. The combined use of catheter thrombectomy and CDT can increase the thrombus removal effect, but it will prolong the postoperative hospital stay and increase the related medical expenses.
作者
田轩
陈耀涵
刘建龙
李金勇
刘笑
张蕴鑫
程志远
贾伟
蒋鹏
周密
田晨阳
TIAN Xuan;CHEN Yaohan;LIU Jianlong;LI Jinyong;LIU Xiao;ZHANG Yunxin;CHENG Zhiyuan;JIAWei;JIANG Peng;ZHOU Mi;TIAN Chenyang(Department of Vascular Surgery,Beijing Jishuitan Hospital,Beijing 100035,China;Peking University Health Science Center,100091,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2022年第6期744-752,共9页
China Journal of General Surgery
基金
首都卫生发展科研专项基金资助项目(首发2022-2-2074)
北京市属医院科研培育基金资助项目(PX2022015)。
关键词
血栓形成
腔静脉
下
腔静脉滤器
血栓切除术
肺栓塞
Thrombosis
Vena Cava,Inferior
Vena Cava Filters
Thrombectomy
Pulmonary Embolism
