腔静脉滤器联合导管接触性溶栓治疗静脉血栓栓塞症临床分析  

Inferior vena cava filter combined with catheter directed thrombolysis for venous thrombotic embolism

作　　者：王曰伟[1] 王豪夫[1] 戚森[1] 刘军军[1] 李君[1] 赵宗刚[1] 

机构地区：[1]青岛大学医学院附属医院血管外科,山东青岛266003

出　　处：《中国血管外科杂志（电子版）》2013年第1期38-40,共3页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的总结腔静脉滤器(IVCF)联合导管接触性溶栓(CDT)治疗下肢深静脉血栓形成(DVT)合并肺栓塞(PE)的临床经验。方法 2008年9月～2012年9月,我科共收治60例下腔静脉和(或)下肢DVT患者,均经CT血管造影确诊,均行IVCF置入并置管溶栓,其中2例为永久性滤器,25例为临时性滤器,33例为可回收滤器。经大隐静脉穿刺置管50例,经腘静脉或小隐静脉穿刺5例,经胫后静脉穿刺4例,足背静脉穿刺1例。术后经溶栓导管泵入肝素和尿激酶,12例Cockett综合征患者行髂静脉血管成形术(PTA)。结果术后2~4(平均3)天,患肢肿胀开始减轻,患肢大腿(髌上15cm或14cm)较对侧粗(3±2.1)cm,小腿(髌下15cm或14cm)较对侧粗(2±1.2)cm。溶栓时间为5~9天,尿激酶总量150万~1000万U,平均772万U。1例合并红斑狼疮患者因多脏器功能衰竭死亡。无严重出血事件发生。3例可回收滤器未取出,滤器取出率为91%。髂静脉PTA后通畅率50%。结论急性下肢DVT患者血栓位置高、病情危重,如果患者没有抗凝和溶栓禁忌证,行IVCF置入并CDT治疗效果好,Cockett综合征PTA术远期疗效尚需进一步观察。Objective To summarize the indications and experience of vena cava filter combined with catheter directed thrombolysis (CDT) in the treatment of lower extremity deep venous thrombosis (DVT) with pulmonary embolism (PE). Methods Sixty cases with inferior vena cava thrombosis or DVT were diagnosed by CTA. All cases underwent inferior vena caver filter (IVCF)(2 permanent filters, 25 temporary filters, and 33 retrievable filters)and CDT. Fifty cases were placed catheter through great saphenous vein, 5 through small saphenous vein or popliteal vein, 4 through posterior tibial vein and 1 through foot dorsal vein. Heparin and urokinase were pumped postoperatively. Besides, 12 cases with Cockett syndrome underwent percutaneous transluminal angioplasty(PTA). Results After operation 2~4 days, the involved limb swelling began to relieve. At last the circumference of the involved thigh was(3±2.1)cm longer than contralateral limb, the circumference of the involved shank was(2±1.2)cm longer than contralateral limb. The dose of urokinase was(1.5~10) million unit, 5~9 days. Among all cases, 1 case with systemic lupus erythematosus died and no severe bleeding event happened. The retrieve rate of filter was 91%.The patency of iliac vein was 50% after PTA. Conclusion IVCF placement combined with CDT treating acute DVT can get good outcome if patients didn't have contraindications for anticoagutive and thrombolytic therapy, The long term results of PTA for Cockett syndrome need to be further studied and followed-up.

关 键 词：深静脉血栓形成 肺栓塞 腔静脉滤器 导管接触性溶栓 COCKETT综合征 

分 类 号：R543.6[医药卫生—心血管疾病]