导管辅助法回收贴壁Günther Tulip滤器的初步经验  

Catheter-assisted retrieval of adhesive Günther Tulip filter: preliminary experience

作　　者：肖亮[1] 童家杰[1] 解世洋[1] 申景[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372-376,共5页Journal of Interventional Radiology

摘　　要：目的回顾导管辅助法回收贴壁Tulip下腔静脉滤器的技巧。方法 2007年11月至2009年10月收治肺动脉栓塞及急性下肢深静脉血栓形成(DVT)患者95例,对其中6例(男4例,女2例;年龄24～71岁,平均43.7岁)单纯捕捉器法未能成功捕获滤器的患者,采用导管辅助法行下腔静脉滤器取出术。具体是在下腔静脉造影证实滤器回收钩贴壁后,使用导管结合鹅颈捕捉器剥离粘连、回收滤器。术后对患者给予抗凝、抗炎治疗3～5 d。随访4～12个月,复查血管超声及肺动脉3D CTA。结果成功回收6例患者的Tulip滤器。采用的操作技术包括导管扭转(1例)、导管成襻(1例)、导管-捕捉器成襻(4例)。回收过程平均用时40.5 min(17～78 min)。滤器在体内留置时间平均为46.7 d(14～80 d)。随访期间未出现下肢静脉血栓形成及肺动脉栓塞。结论导管辅助法对于贴壁Tulip滤器的回收率较高,可明显提高Tulip下腔静脉滤器回收成功率。Objective To retrospectively summarize the technical experience in performing catheter-assisted retrieval of adhesive Günther Tulip filter.Methods During the period from November 2007 to October 2009,95 patients with pulmonary embolism and acute deep vein thrombosis of lower limbs were admitted to authors＇ hospital.As simple snare technique failed to catch the adhesive Günther Tulip filter previously implanted in inferior vena cava（IVC） in 6 patients（four males and two females with a mean age of 43.7 years）,catheter-assisted retrieval of adhesive Günther Tulip filter had to be carried out.The specific procedure was as follows.After phlebography of IVC confirmed that the filter＇s retrieval hook had adhered to IVC wall,the adhesion was separated with the help of catheter as well as goose-neck capturing device,then,the Günther Tulip filter was retrieved.After the procedure,both anticoagulation and antibiotic medication were employed for 3-5 days.All the patients were followed up for 4-12 months.Vascular ultrasonography and pulmonary 3D CTA were re-examined in 6 months after primary operation.Results All 6 adhesive Günther Tulip filters were successfully removed with a success rate of 100%.The manipulation used in the procedure included catheter-twisting technique（n = 1）,catheter-looping technique（n = 1） and catheter-snare looping technique（n = 4）.The mean operation time was 40.5 minutes（in the range of 17-78 minutes）.The average filter-dwelling time was 46.7 days（ranging from 14 to 80 days）.No thrombus formation in deep veins of lower extremity or pulmonary embolism occurred during the follow-up period.Conclusion The catheter-assisted retrieval technique carries high retrieval rate for adhesive Günther Tulip filter in IVC,it can markedly improve the retrieval success rate of Tulip IVC filter.

关 键 词：静脉血栓形成 肺栓塞 导管辅助 Günther Tulip滤器 

分 类 号：R543.6[医药卫生—心血管疾病]