腹腔镜下腔静脉滤器取出术安全性与可行性分析  

Safety and feasibility of laparoscopic retrieval of inferior vena cava filters

作　　者：王海东[1] 刘建龙[2] 朱晓斐[1] 王海[1] 李贵忠[1] 周宁[1] 贾伟[2] 蒋鹏[2] 满立波[1] WANG Haidong;LIU Jianlong;ZHU Xiaofei;WANG Hai;LI Guizhong;ZHOU Ning;JIA Wei;JIANG Peng;MAN Libo(Department of Urology,Beijing Jishuitan Hospital,Beijing 100096,China;Department of Vascular Surgery,Beijing Jishuitan Hospital,Beijing 100096,China)

机构地区：[1]北京积水潭医院泌尿外科,北京100096 [2]北京积水潭医院血管外科,北京100096

出　　处：《中国普通外科杂志》2020年第12期1468-1474,共7页China Journal of General Surgery

摘　　要：背景与目的:笔者所在医院自2016年率先在国内开展腹腔镜下腔静脉取滤器手术以来,已进行了多例该项手术。本文通过分析10例行该手术患者的临床资料,总结两种腹腔镜下腔静脉滤器取出的手术途径(经腹腔途径、经腹膜后途径)的手术经验,为开展及推广该手术提供参考。方法:回顾性分析2016年12月—2018年11月10例行腹腔镜下腔静脉滤器取出术的患者临床资料。其中男7例,女3例;年龄24~66岁,平均(47±12.5)岁;经CT分型:滤器头端位于肾静脉水平以上1例,位于肾静脉水平4例,位于肾静脉水平以下5例;滤器头端贴近下腔静脉前壁或前侧壁者5例,贴近后外侧壁者4例,位于下腔静脉腔内者1例。9例患者置入Cook Celect滤器,1例患者置入Denali滤器。所有滤器均为可回收滤器。患者均在当地医院置入,因髂静脉及下肢静脉血栓形成而预防性置入滤器7例,因肋骨及骨盆多发骨折而预防性置入滤器1例,因下肢静脉血栓致肺栓塞而置入滤器2例,患者既往均在当地医院腔内取滤器失败次数1~3次失败后转入我院。10例患者均行下腔静脉滤器取出术,包括经腹腔途径6例,经腹膜后途径4例。手术通常放置3~4个Trocar,游离下腔静脉,根据CT检查,找到滤器头端的具体位置,纵行切开下腔静脉,取出滤器。术后注意观察引流情况,24 h经腹腔途径引流量50 mL以下,经腹膜后途径引流20 mL以下即可拔出引流管。根据引流情况,术后24~48 h皮下注射低分子量肝素钠注射液,防止下肢深静脉血栓形成。患者第2天开始进流质饮食,并逐渐过渡至普通饮食,鼓励患者适度下床活动。结果:10例患者中9例腹腔镜下腔静脉滤器取出成功,1例未成功。下腔静脉阻断1例,阻断时间20 min,其余未阻断。手术时间150~420 min,平均(253.5±86.7)min;术中出血量10~500 mL,平均(67.0±152.6)mL;9例出血量较少(10~50 mL),未输血,1例患者出血500 mL,输悬浮红细胞Background and Aims:Since the authors’hospital initially conducted laparoscopic retrieval of inferior vena cava(IVC)filters in 2016,a number of cases of this operation have been performed.The aim of this article is to summarize the surgical experience of two approaches(transperitoneal approach and retroperitoneal approach)of laparoscopic retrieval of IVC filters by analyzing the clinical data of 10 patients undergoing this operation,so as to provide a reference for its popularization and promotion.Methods:The clinical data of 10 patients undergoing laparoscopic retrieval of IVC filters during December 2016 and November 2018 were retrospectively analyzed.Among these patients,7 were males and 3 were females,aged from 24 to 66 years,with an average age of(47±12.5)years.CT findings were that the head of the IVC filter dislocated above the renal vein in 1 case,at the renal vein level in 4 cases,and inferior to renal vein in 5 cases;the head of the IVC filter located close to the anterior or anterior lateral wall of the IVC in 5 cases,posterior lateral wall of the IVC in 4 cases,and in the lumen of the IVC in 1 case.All IVC filters were retrievable filters,including Celect filter used in 9 cases,and Denali filter in 1 case.All filters were inserted in others hospital.Seven patients underwent prophylactic placement of IVC filters due to iliac and lower extremity venous thrombosis,one case underwent prophylactic placement of IVC filters due to multiple traumatic rib and pelvis fractures,and IVC filter placement for 2 patients was in the setting of acute pulmonary embolism due to deep venous thrombosis.All patients were transferred to our hospital after previous endovascular retrieval failure for 1-3 times in other hospitals.All the 10 patients underwent laparoscopic IVC filter retrieval through transperitoneal approach in 6 cases and through retroperitoneal approach in 4 cases.Using a standard 3-port or 4-port technique,the IVC was dissected,the location of filter hook was found according to CT scan,a longitudinal inc

关 键 词：腔静脉滤器 滤器取出术 腹腔镜 

分 类 号：R654.3[医药卫生—外科学]