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目的:评价置入下腔静脉滤器预防因下肢静脉血栓脱落引起肺栓塞的效果和安全性。材料和方法:40例下肢深静脉血栓患者,男23例,女17例,年龄31～79岁,中位年龄58岁。经下肢静脉造影证实有股髂静脉血栓,病变位于左下肢26例,右下肢10例,双下肢4例,同时16例经多普勒检查诊断。经股静脉或颈静脉穿刺置入下腔静脉滤器,术后分别于1,6,12个月摄腹部平片复查,以后每年复查腹部平片,观察滤器的位置、形态变化。结果:放置滤器42枚,经颈静脉穿刺4例,经右股静脉28例,经左股静脉10例,包括钛质Greenfieldfilter(TKG)14例,Bird’snestfilter(BNF)12例,Si-mon镍钛下腔静脉滤器10例,Tulip滤器3例(2枚已取出),Trapease滤器3例。滤器位于双肾静脉水平以下的腔静脉内。无严重并发症发生。随访发现2例TKG向足侧移位,1例TKG向头侧移位,2例BNF跨度增大,腹部CT,腔静脉造影发现一只脚穿透腔静脉壁,未出现任何症状,4例TKG和1例SNF发生滤器偏斜,角度小于15°。无1例发生腔静脉阻塞或复发肺栓塞。结论:置入下腔静脉滤器预防肺栓塞是安全、有效的方法。
Objective: To evaluate the effectiveness and safety of inferior vena cava filters in preventing pulmonary embolism caused by exfoliation of venous thrombi in lower extremities. Materials and Methods: Forty patients with deep venous thrombosis of the lower extremities were enrolled in this study. There were 23 males and 17 females with a median age of 58 years (range, 31-79 years). The iliac vein thrombosis confirmed by lower extremity venography, lesions in the left lower limb in 26 cases, 10 cases of right lower limbs, 4 cases of both lower extremities, while 16 cases were diagnosed by Doppler. The femoral venous or jugular vein puncture into the inferior vena cava filter, respectively, after 1, 6, 12 months to take abdominal plain film review, after each review of abdominal plain film, observe the filter position, morphological changes. Results: Forty-two filters were placed through the jugular vein in 4 cases, right femoral vein in 28 cases and left femoral vein in 10 cases. Among them, there were 14 cases of titanium oxide (TKG), 12 cases of Bird’s Nest filter (BNF) Nitinol vena cava filter in 10 cases, Tulip filter in 3 cases (2 removed), Trapease filter in 3 cases. The filter is located within the vena cava below the level of the renal vein. No serious complications occurred. Followed up two cases of TKG shift to the foot side, one case of TKG shift to the head, two cases of BNF span increased, abdominal CT, vena cava found one foot through the vena cava wall, no symptoms, 4 cases TKG and 1 case of SNF filter deflection angle of less than 15 °. No case of vena cava occlusion or recurrent pulmonary embolism. Conclusion: Inferior vena cava filter to prevent pulmonary embolism is a safe and effective method.