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目的探讨Günther Tulip可回收式腔静脉滤器在下肢深静脉血栓形成介入治疗中的应用效果及操作技术。方法 2007年9月至2008年4月于我院就治的急性下肢深静脉血栓形成患者36例,发病时间1～12h,发病诱因包括术后及骨折后卧床18例、产后5例、无明显诱因13例;合并肺动脉栓塞12例。症状表现为患肢肿胀(患肢大腿周径比健侧大3～10cm)、疼痛、皮肤呈青紫色或苍白,皮温升高或正常,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45～75d经血管超声及血管造影复查证实下肢静脉及肺动脉内无新鲜或游离血栓后,经右颈内静脉入路行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3～5d。随访4～10个月。结果共置入Günther Tulip可回收式腔静脉滤器36枚,均一次性释放成功,释放过程平均耗时1.5min(0.5～5min),释放过程中滤器弹跳幅度小于2mm,1例滤器置入时倾斜25°,滤器置入后未出现新发生肺动脉栓塞的临床表现。12例患者于术后45～75d行Günther Tulip腔静脉滤器取出术,均一次性回收成功,回收过程耗时4.4min(2～15min),下腔静脉造影复查未见管壁穿孔及破裂征象。其余24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 Günther Tulip可回收式腔静脉滤器具有释放定位准确、捕获血栓能力较高、可取出时间期限长(溶栓治疗时间窗长)、回收成功率高等优点,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 effect and technique of Günther Tulip recoverable caval filter in the interventional treatment of deep venous thrombosis of the lower extremities. Methods Thirty-six patients with acute DVT in our hospital from September 2007 to April 2008 were enrolled in this study. The onset time ranged from 1 to 12 hours. The predisposing factors included 18 cases of postoperative bed rest and 5 postpartum cases without obvious Incentives in 13 cases; pulmonary embolism in 12 cases. Symptoms manifested as limb swelling (limb thigh diameter than the contralateral large 3 ~ 10cm), pain, skin was purple or pale, skin temperature increased or normal, with pulmonary embolism were manifested as 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 45 ~ 75d by vascular ultrasound and angiography confirmed lower extremity venous and pulmonary artery without fresh or free thrombosis, the right internal jugular vein approach Günther Tulip vena cava removed, review of inferior vena cava angiography. After giving anticoagulant, anti-inflammatory treatment of 3 ~ 5d. Follow-up 4 to 10 months. Results A total of 36 Günther Tulip vena cava filters were successfully inserted. The average release time was 1.5 min (0.5-5 min). The bounce amplitude of the filter during release was less than 2 mm. One of the filters was tilted 25 °, the filter does not appear after the new occurrence of pulmonary embolism clinical manifestations. Twelve patients underwent Günther Tulip vena cava filter at 45-75 days postoperatively. All of them were successfully recovered in one time. The recovery time was 4.4 minutes (2-15 minutes). No signs of perforation and rupture of the vessel wall were observed after IVC angiography. The remaining 24 patients without filter removal surgery, did not appear during follow-up of pulmonary embolism and clinical manifestations of inferior vena cava occlusion. Conclusions The Günther Tulip recoverable vena cava filter has the advantages of accurate release and positioning, high capability of capturing thrombus, long time-to-take (long time of thrombolytic treatment) and high success rate of recovery, and clinical application in deep venous thrombosis interventional therapy Good effect, high success rate of technical operations.