可回收腔静脉滤器在骨创伤合并下肢深静脉血栓形成的应用  

The application of retrievable vena cava filters in patients of bone fracture combined with deep venous thrombosis

作　　者：潘烨[1] 邵明哲[1] 张健[1] 吴海生[1] 梅家才[1] 张长青[2] 孙玉强[2] 赵珺[1] 

机构地区：[1]上海交通大学附属第六人民医院 血管外科,上海200233 [2]上海交通大学附属第六人民医院 骨科,上海200233

出　　处：《中国血管外科杂志（电子版）》2013年第3期161-165,共5页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探讨可回收腔静脉滤器在骨创伤合并下肢深静脉血栓形成(DVT)患者中的应用和提高滤器取出率的途径。方法对2007年7月~2012年12月我院收治的486例骨创伤合并下肢DVT(均经下肢血管多普勒超声检查诊断)患者的临床资料进行回顾性分析。患者于骨科手术前均置入可回收滤器,以预防围手术期发生致命性肺梗塞(PE)。采用圈套器联合导丝牵拉法处理倾斜滤器;对滤器内大块血栓置管溶栓治疗。结果 486例可回收腔静脉滤器均置入成功。围手术期无症状性PE发生。滤器在体内的留置时间为(18.4±4.3)d,其中152例捕获到血栓。447例患者进行了滤器取出操作,共取出滤器441个,技术成功率为98.7%,6例取出失败。总的滤器取出率为90.7%。结论可回收滤器用于骨创伤合并下肢DVT患者可有效预防PE。完善的患者信息登记和随访、妥善处理滤器内血栓和滤器倾斜,有助于提高滤器取出率,更好地发挥可回收滤器的优势。Objective To evaluate the application of retrievable inferior vena cava filter (rIVCF) in patients of bone fracture combined with deep venous thrombosis (DVT) , and the methods to improve the rIVCF retrieval rates. Methods From July 2007 to December 2012, the clinical data of 486 cases of bone fracture combined with DVT were studied retrospectively, and the patients were diagnosed by Doppler ultrasound. Patients were received rIVCF implantation before orthopedic surgery to prevent the perioperative pulmonary embolism (PE). The snare-over-guide wire loop technique was used to handle with tilted filters. Thrombolytic therapy was applied to deal with large thrombus trapped in filters. Results All of the 486 rIVCFs were successfully deployed. No PE occurred in the perioperative period. The mean implanting time of rIVCFs in inferior vena cava was (18.4±4.3) days, and among which, trapped thrombi were found in 152 cases. 447 rIVCFs were attempted to be removed, but failed in six cases. The technique success ratio of retrieving was 98.7%, while the total retrieval rate was 90.7%. Conclusion rIVCF can prevent trauma patients with DVT from fatal PE. Comprehensive patient registration, strict follow-up, proper management with tilted filters and large thrombus in filters contribute to the improvement of retrieval rates.

关 键 词：静脉血栓形成 肺栓塞 腔静脉滤器 骨折 

分 类 号：R654.3[医药卫生—外科学]