永久性下腔静脉滤器置入术有效性及安全性.docVIP

永久性下腔静脉滤器置入术有效性及安全性 　 作者：陈忠，吴庆华，寇镭，杨宝钟，韩延民，唐小斌，吴章敏，刘晖，霍昕 【摘要】 目的 探讨永久性下腔静脉置入术预防致命性肺栓塞的有效性、安全性和手术指征，以及相关并发症出现的原因和预防措施。方法 1999年12月～2005年6月，经颈内静脉或股总静脉放置永久性下腔静脉滤器89例，术前均经彩色超声确诊下肢深静脉血栓（deep vein thrombosis，DVT)。术中常规行下腔静脉造影，确定下腔静脉和释放途经静脉无血栓形成，将滤器放置于平肾静脉开口之下的下腔静脉。结果 本组病例均获成功。术后1～70个月随访，无有症状的肺栓塞发生者，术后下腔静脉血栓形成2例；滤器倾斜5例，倾斜角度小于15°。无其他相关并发症。结论 永久性下腔静脉滤器置入术可以有效地预防致命性肺栓塞。严格掌握下腔静脉滤器（inferior vena cava filter，VCF)的指征是重要的。术前行彩超和术中下腔静脉造影，了解下腔静脉和滤器放置通路的情况；术中操作要点的实施，以及术后严格的抗凝治疗，是确保放置成功、有效预防肺动脉栓塞（pulmonary embolism，PE）、避免或降低并发症出现的关键。 【关键词】 肺栓塞；腔静脉滤器；抗凝 【Abstract】 Objective To assess the efficiency safety and indications of permanent inferior vena cava filters placement for prophylaxis against pulmonary embolism and analyse the complications of permanent inferior vena cava filters placement then how to prevent it.Methods From Dec 1999 to Jun 2005，89 cases were treated with permanent inferior vena cava filters，by way of the internal jugular vein and the common femoral vein.All patients had DVT confirmed by Doppler ultrasound.Cavography were performed routinely before inserting the VCF to confirm no thrombosis in IVC and access veins.The insertion site for filters is the subrenal vena cava.Results Technical successes were achieved in all cases and a clinical success of 100% that no case of symptomatic PE occurred during 1～70 months follow-up.There were 2 cases of IVC thrombosis at the site of insertion and 5 cases of filter tilting less than 15.There were no events of other complications.Conclusion Permanent IVC filter placement is an effective and safe method for preventing fatal PE due to DVT.The filter placement indications should be strict.Imaging of the vena cava and access vein by venous ultrasound and cavography，strict anticoagulation therapy after VCF insertion are key to VCF placement，provide protection from recurrent life-threatening PE and reduce complications. 【Key words】 pulmonary embolism；vena cava filters；anticoagulants 肺动脉栓塞（pulmonary embolism，PE)的发病率高、致死率高，还可以导致慢