下腔静脉滤器继发血栓形成的治疗  

Treatment for thrombosis secondary to the inferior vena cava filter placement

作　　者：李艳奎[1] 陈剑秋[1] 吴义生[1] 李学东[1] 高洁[1] 张韬[2] 李清乐[3] 张翔宇[3] 沈晨阳[3] 张小明[3] 

机构地区：[1]天津医科大学第二医院血管外科,300211 [2]解放军总医院血管外科 [3]北京大学人民医院血管外科

出　　处：《中华普通外科杂志》2014年第5期370-372,共3页Chinese Journal of General Surgery

摘　　要：目的分析下腔静脉滤器（inferior vena cava filter，IVCF）继发血栓形成的治疗方法及疗效。方法回顾性分析2007年8月至2012年9月序贯治疗的10例混合型下肢深静脉血栓形成滤器置入术后继发血栓形成患者的临床资料。结果男6例，女4例，年龄（58±9）岁。本组10例患者中，滤器下方血栓形成9例，滤器内、上方及下方合并血栓形成1例；所有患者均在低分子肝素钙抗凝治疗同时，导管接触溶栓（catheter—directedthrombolysis，CDT）8例，静脉药物溶栓2例；CDT后分别造影，下腔静脉血栓完全溶解7例、部分溶解1例；临时性滤器顺利取出2例、放弃取出I例；本组患者治疗期间无肺栓塞发生；随访3～48个月，平均（22±10）个月，随访率为100％，随访期间死亡率为10％。经静脉药物溶栓2例，下肢、会阴部肿胀及疼痛仅略有减轻，而经CDT8例，下肢、会阴部肿胀及疼痛均明显缓解，其中2例腰部胀痛完全消失。结论ICVF继发血栓形成，应在充分抗凝同时，积极溶栓治疗，CDT是一种可行的有效方法，可降低后遗症的发生率。Objective To evaluate the treatment results for patients with thrombosis secondary to the inferior vena cava filter（IVCF） placement. Methods A retrospective analysis of the clinical data was performed for patients with thrombosis secondary to the IVCF from Aug 2007 to Sep 2012. Results In 10 IVCF patients, 9 was below the IVCF thrombosis, 1 patient with thrombosis all over the IVCF;On the basis that all patients were put on anticoagulant therapy of low molecular heparin calcium, 8 patients received catheter-directed thrombolysis（ CDT）, 2 patients received intravenous thrombolytic drug administration, after CDT angiography, showed that thrombus was completely dissolved in 7 patients and partly dissolved in 1 patient. Temporary filter was taken out in 2 patients, left in place in one. No pulmonary embolism took place in the study. All 10 patients were followed up from 3 months to 48 months, with one death. The swelling and pain of the lower limb and perineum were not significantly relieved in the 2 patients treated by venous thrombolytic drug, while these symptoms improved significantly in all the 8 CDT cases, and in 2 patients the lumbar swelling disappeared. Conclusions Treatment of thrombosis secondary to IVCF should be based on sufficient systemic anticoagulation and CDT.

关 键 词：静脉血栓形成 腔静脉滤器 血栓溶解疗法 

分 类 号：R654.4[医药卫生—外科学]