经颈静脉回收Günther Tulip腔静脉滤器的初步经验  

The initial experience of transjugular retrieval of Günther Tulip inferior vena cava filters

作　　者：肖亮[1] 申景[1] 童家杰[1] 李海伟[1] 徐克[1] 

机构地区：[1]沈阳中国医科大学附属第一医院放射科,110001

出　　处：《介入放射学杂志》2011年第5期366-371,共6页Journal of Interventional Radiology

基　　金：国家十一五科技支撑计划(2007BAI05B04)

摘　　要：目的探讨经颈静脉回收Günther Tulip腔静脉滤器的适应证选择及操作技术。方法 2007年9月至2009年3月于中国医科大学附属第一医院就治的急性下肢深静脉血栓形成患者74例,发病时间1～14 d。症状表现为患肢肿胀、疼痛、皮肤呈青紫色或苍白,皮温升高或正常,31例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12～80 d经复查血管超声及血管造影证实下肢静脉及肺动脉内无新鲜或游离血栓后,经颈内静脉入路行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3～5 d。随访4～12个月。结果共置入Günther Tulip可回收式腔静脉滤器74枚,均一次性释放成功,1例滤器置入时倾斜25°。41例患者于术后41.3 d(12～80 d)经颈静脉行Günther Tulip腔静脉滤器取出术,成功率达97.6%,回收过程平均耗时5.8 min(1～115 min),下腔静脉造影复查未见管壁穿孔及破裂征象。成功回收的病例均一次性回收成功,1例因滤器与血管壁致密融合导致回收失败。其余33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。结论经颈静脉回收Günther Tulip可回收式腔静脉滤器具有回收成功率高、并发症少等优点,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 explore the indications and technical procedures of transjugular retrieval of Günther Tulip inferior vena cava filters.Methods Seventy-four patients（40 males and 34 females with a mean age of 45.8 years） with acute lower extremity deep venous thrombosis encountered in our hospital from September 2007 to Mar 2009were involved in this study.The onset of the disease was from one day to 14 days.Clinical symptoms included swelling,pain,cyanosis or pallescence of the affected limb with higher or normal skin temperature.Thirty-one patients who complicated with pulmonary embolism suffered from dyspnoea,chest pain,hemoptysis,etc.Implantation of Günther Tulip retrievable inferior vena cava filters through femoral or right internal jugular vein was carried out,which was followed by intravenous transcatheter thrombolysis.Vascular ultrasound and angiography showed no fresh or free thrombus in 12-80 days after initial treatment,then the Günther Tulip filter was taken out from right internal jugular vein,and inferior vena cavography was performed again.All patients accepted anticoagulation and antibiotic treatment for 3-5 days after operation.A follow-up lasting for 4-12 months was made.Results Successful implantation of Günther Tulip retrievable inferior vena cava filter with only one session was obtained in all 74 patients.During implantation procedure one filter became tilted 25 degrees.Successful removal of Günther Tulip retrievable inferior vena cava filter was achieved in 40 patients in 41.3 days（12-80 days）after the filter was delivered,and the procedure cost only 5.8 minutes（1-115 minutes） with a successful rate of 97.6%（40/41）.Failure of retrieval of IVC filter due to compact adhesion of the filter to IVC wall happened in one patient.Inferior vena cavography again confirmed that there was no any sign of vascular perforation or rupture.Retrieval of IVC filter was not performed in other 33 patients and no clinical manifestations of pulmonary embolism or inferior vena cava occlusion emerg

关 键 词：深静脉血栓形成 腔静脉 可回收滤器 效果操作 

分 类 号：R543.6[医药卫生—心血管疾病]