可回收下腔靜脈濾器取出術(shù)相關(guān)并發(fā)癥探討

曲凡勇　李旺麗

可回收下腔靜脈濾器取出術(shù)相關(guān)并發(fā)癥探討

曲凡勇李旺麗

目的探討可回收下腔靜脈濾器取出技巧及出現(xiàn)的相關(guān)并發(fā)癥。方法收集2008年5月—2015年3月接受彩超檢查發(fā)現(xiàn)下肢深靜脈血栓形成并置入可回收濾器的72例病人，對其中的35例溶栓效果良好且無發(fā)生肺栓塞風(fēng)險的病人行下腔靜脈濾器取出術(shù)。結(jié)果35例病人中下腔靜脈濾器成功取出33例，取出率94%，其中有3例病人取出濾器后發(fā)現(xiàn)濾器內(nèi)捕獲血栓，2例濾器取出過程中及術(shù)后造影發(fā)現(xiàn)下腔靜脈穿孔，1例發(fā)生頑固性心律失常，經(jīng)積極對癥處理后未發(fā)現(xiàn)癥狀性肺栓塞及猝死等嚴(yán)重情況。另外2例取出失敗后轉(zhuǎn)為永久留置。結(jié)論規(guī)范、熟練地操作下腔靜脈濾器取出術(shù)既可以避免下腔靜脈濾器長期留置的遠(yuǎn)期并發(fā)癥，同時也減少下腔靜脈濾器取出術(shù)操作中并發(fā)癥的發(fā)生。

下腔靜脈濾器；并發(fā)癥；下肢深靜脈血栓；肺栓塞；介入放射學(xué)

DOI：10.19300/j.2016.L3655

【Abstract】ObjebtiveTo explore the techniques and related complications of removing retrievable inferior vena cava filter.MethodsFrom May 2008 to March 2015，seventy-two patients with lower limb deep vein thrombosis formation clearly diagnosed by color Doppler ultrasound were imbedded retrievable filter.The inferior vena cava filter was removed from thirty-five cases who had successful thrombolysis and no risk of pulmonary vein thrombosis.ResultsThe inferior vena cava filter was successfully removed in thirty-three of thirty-five（94%）cases.Among the thirty-three cases，three cases revealed capture thrombus inside filter after removal，two cases revealed interior vena cava perforation during removal process and on postoperative angiography，and one case suffered from intractable arrhythmia without pulmonary embolism and sudden death after positive symptomatic treatment.The remain two cases of failed removal turned into permanent indwelling.Conclusion Normative and skilled removal of inferior vena cava filter can avoid long-term complications of chronically indwelling of inferior vena cava filter，and can reduce the occurrence of complications of removing inferior vena cava.

【Key words】Inferiorvenacavafilter；Complication；Deepvenousthrombosis；Pulmonaryembolism；Interventionalradiology

Int J Med Radiol，2016，39（2）：120-122

下腔靜脈濾器（inferior vena cava filter，IVCF）置入術(shù)使下肢深靜脈血栓（deep vein thrombosis，DVT）導(dǎo)致的肺栓塞（pulmonary embolism，PE）發(fā)生率降至0.9%～5%［1］，被臨床醫(yī)師公認(rèn)為是預(yù)防PE的安全有效方法。但隨著IVCF的廣泛應(yīng)用，多項研究報道，置入體內(nèi)的下腔靜脈濾器可出現(xiàn)不同概率的折斷、移位、脫落，下腔靜脈內(nèi)血栓，下腔靜脈穿孔等近期及遠(yuǎn)期并發(fā)癥［2-5］。在溶栓完畢并保證安全的情況下，IVCF的取出成為減少IVCF置入后上述并發(fā)癥的良策。但同時也出現(xiàn)了IVCF取出操作的相關(guān)并發(fā)癥。本研究就可回收下腔靜脈濾器取出方法及取出術(shù)中相關(guān)并發(fā)癥進(jìn)行探討分析。……