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目的探讨经颈静脉回收Günther Tulip腔静脉滤器的适应证选择及操作技术。方法 2007年9月至2009年3月于中国医科大学附属第一医院就治的急性下肢深静脉血栓形成患者74例,发病时间1～14 d。症状表现为患肢肿胀、疼痛、皮肤呈青紫色或苍白,皮温升高或正常,31例合并肺动脉栓塞者表现为呼吸困难、胸痛、咯血等。分别经股静脉或经右颈内静脉置入Günther Tulip可回收式腔静脉滤器后,均行静脉内置管溶栓治疗。术后12～80 d经复查血管超声及血管造影证实下肢静脉及肺动脉内无新鲜或游离血栓后,经颈内静脉入路行Günther Tulip腔静脉滤器取出术,复查下腔静脉造影。术后给予抗凝、抗炎治疗3～5 d。随访4～12个月。结果共置入Günther Tulip可回收式腔静脉滤器74枚,均一次性释放成功,1例滤器置入时倾斜25°。41例患者于术后41.3 d(12～80 d)经颈静脉行Günther Tulip腔静脉滤器取出术,成功率达97.6%,回收过程平均耗时5.8 min(1～115 min),下腔静脉造影复查未见管壁穿孔及破裂征象。成功回收的病例均一次性回收成功,1例因滤器与血管壁致密融合导致回收失败。其余33例患者未行滤器取出术,随访期间未出现肺动脉栓塞及下腔静脉闭塞的临床表现。结论经颈静脉回收Günther Tulip可回收式腔静脉滤器具有回收成功率高、并发症少等优点,在下肢深静脉血栓介入治疗中的临床效果良好,技术操作成功率较高。
Objective To investigate the indications and operation techniques for the recovery of Günther Tulip vena cava filters through the jugular vein. Methods From September 2007 to March 2009, 74 cases of acute lower extremity deep vein thrombosis were treated in the First Affiliated Hospital of China Medical University, with a onset time of 1 to 14 days. Symptoms manifested as limb swelling, pain, skin was purple or pale, skin temperature increased or normal, 31 cases of pulmonary embolism showed dyspnea, chest pain, hemoptysis. After the femoral vein or right internal jugular vein into the Günther Tulip recoverable vena cava filter, intravenous catheter thrombolytic therapy. Postoperative 12 ~ 80 d confirmed by retrospective vascular ultrasound and angiography in the lower extremity veins and pulmonary artery without fresh or free thrombosis, via the internal jugular vein line Günther Tulip vena cava removed, review of inferior vena cava angiography. Postoperative anticoagulant, anti-inflammatory treatment of 3 ~ 5 d. Follow-up 4 to 12 months. Results A total of 74 Günther Tulip retractable vena cava filters were successfully implanted in one time and 25 ° in one filter. Forty-one patients underwent Günther Tulip vena cava filter through the jugular vein at 41.3 days (range, 12 to 80 days) after operation. The success rate was 97.6%. The mean recovery time was 5.8 min (range, 1 to 115 min) Review no signs of wall perforation and rupture. Successfully recovered cases were a one-time recovery success, 1 case due to the filter and vascular wall dense fusion lead to recovery failure. The remaining 33 patients without filter removal surgery, did not appear during follow-up pulmonary embolism and clinical manifestations of inferior vena cava occlusion. Conclusions The Günther Tulip recoverable vena cava filter through the jugular vein has the advantages of high recovery success rate and few complications. It has a good clinical effect in the interventional treatment of deep venous thrombosis of the lower extremities and has a high success rate of technical operation.