锥形腔静脉滤器致管壁损伤及修复的实验研究  

Experimental study on the injury and repair of the wall of the vena cava caused by the conical vena cava filter

作　　者：田轩[1] 刘建龙[1] 田萌萌[2] 张蕴鑫 贾伟[1] 蒋鹏[1] 程志远[1] 李金勇 田晨阳[1] 姚晓东[3] Tian Xuan;Liu Jianlong;Tian Mengmeng;Zhang Yunxin;Jia Wei;Jiang Peng;Cheng Zhiyuan;Li Jinyong;Tian Chenyang;Yao Xiaodong(Department of Vascular Surgery,Beijing Ji-Shui-Tan Hospital,Beijing 100035,China;Department of Pathology,Beijing Ji-Shui-Tan Hospital,Beijing 100035,China;Department of Medical Services,Beijing Ji-Shui-Tan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院血管外科,100035 [2]北京积水潭医院病理科,100035 [3]北京积水潭医院医务处,100035

出　　处：《中华实验外科杂志》2021年第5期802-805,共4页Chinese Journal of Experimental Surgery

摘　　要：目的探讨锥形滤器对动物下腔静脉管壁的损伤与修复,为临床合理、安全的应用滤器提供理论依据。方法2016年5月至2017年4月对19只羊置入锥形滤器,北方小尾寒羊种。滤器取出时使用抽签法随机选择动物取材下腔静脉管壁,留置14 d直接处死和介入回收后处死各1只,留置28、42、56、84 d直接处死1只、介入回收后处死2只和介入回收饲养28 d后处死1只,留置180 d直接处死1只。比较置入前后、取出前下腔静脉直径、倾斜角度和回收力;静脉壁病理切片行苏木精-伊红(HE)染色和马松(Masson)染色,判断损伤程度、炎性反应、滤器内皮化和内膜增生程度。组间计量资料比较采用秩和检验,组间等级资料比较采用Fisher精确概率法。结果19枚滤器成功放置和取出,成功率100%;置入前直径(20.41±3.27)mm,置入后直径(20.24±2.91)mm,取出前直径(19.63±1.58)mm,差异无统计学意义(Z=0.778、-0.282,P>0.05);滤器接触内膜粗糙,无接触内膜光滑,回收饲养28 d后处死,置入28、42 d的动物静脉壁接近正常无明显损伤,置入56、84 d的动物静脉壁有轻微损伤伴滤器接触内膜稍增厚;HE和Masson染色病理分析,内膜炎性细胞浸润程度与滤器留置时间无明显相关性,滤器脚支未穿透静脉壁,静脉壁损伤可恢复。结论锥形滤器应用安全,滤器置入和取出对下腔静脉管壁损伤小且可修复。Objective To investigate the damage and repair of the conical filter on the wall of inferior vena cava(IVC)in animals.Methods From May 2016 to April 2017,19 northern small-tailed Han sheep were placed with cone filters.The IVC wall was sampled directly when retrieving the filter.When the filter was put in 14 days,one sheep was killed directly and another one was put to death after the filter was interventionally retrieved.At the date of the filter put in 28,42,56,84 d,one sheep was ececuted directly and another two ones were sacrificed after the filter was interventionally removed.One sheep was killed after 4 weeks of feeding since the filter was interventionally retrieved.One sheep was sacrificed directly when the filter was implanted for 180 days.The diameter of IVC before and after filter insertion and removal,the inclination angle,and the recovery force of the filter were compared.The IVC pathological sections were stained with hematoxylin-eosin(HE)and Masson to observe the degree of injury,inflammatory response,endothelialization of the filter,and hyperplasia of the intima of the vein wall.Categorical variables were compared with the Fisher’s exact test.Continuous variables were compared with the Wilcoxon test.Results A total of 19 conical filters were successfully placed and removed,and the success rate of implantation and removal was 100%.The diameter of IVC was(20.41±3.27)mm before filter placement,(20.24±2.91)mm after filter placement,and(19.63±1.58)mm before filter removal,showing no statistical difference(Z=0.778,-0.282,P>0.05).Immediately after the filter was removed,the contact intima of IVC specimen was rough,and the contact intima of vessels without a filter was smooth.After 28 d,the animals were killed.The wall of IVC was almost normal and no obvious injury was found in the animals implanted for 4 and 6 weeks.The animals implanted for 8 and 12 weeks showed slight injury with a slightly thickened contact membrane of the filter.Pathological analysis of HE and Masson staining showed that there w

关 键 词：腔静脉滤器 下腔静脉 损伤 修复 

分 类 号：R654.3[医药卫生—外科学]