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目的采用体外下腔静脉(IVC)模型探讨经股静脉Günther Tulip滤器(GTF)置入发生倾斜的机制。方法体外IVC模型由悬吊于透明、分叉玻璃管中的1支直径25 mm、长10 cm涤纶人工血管及2支直径10 mm、长10 cm涤纶人工血管构成。经股静脉GTF置入分为两组:右直组(GRS)(n=100)和左直组GLS(n=100)。测量并记录腔静脉右侧壁与钩的距离(DCH),根据DCH滤器倾斜程度(DT)分为5级。滤器释放前、后,分别测量各组金属罩杯与IVC纵轴夹角(ACM1,2)和腔静脉右侧壁与金属罩杯的距离(DCM1,2)。另外还测量各组释放后IVC纵轴与滤器纵轴夹角(ACF)以及IVC的直径(DIVC)。结果每组GTF的倾斜程度分布各不相同。GRS中,滤器倾斜程度属于Ⅲ级的例数与GLS中相应的例数差异有统计学意义(59%与36%,P=0.003)。两组间大多数测量值差异有统计学意义。两组中ACM1与ACF,ACM1-ACM2与DCH1-DCH2之间均呈明显正相关;两组中DCH1与ACF之间呈明显负相关。结论释放前滤器与IVC的倾斜角是造成经股静脉GTF置入后倾斜的主要原因。
Objective To investigate the mechanism of incarceration through the femoral vein Günther Tulip filter (GTF) by using in vitro IVC model. Methods The in vitro IVC model consisted of one 25 mm long, 10 cm long, polyester artificial blood vessel suspended in a clear, bifurcated glass tube and two 10 mm diameter polyester artificial blood vessels. The femoral vein GTF was divided into two groups: right straight group (GRS) (n = 100) and left straight group GLS (n = 100). The distance (DCH) between the right side wall of the vena cava and the hooks was measured and recorded, and was divided into five levels according to the inclination of the DCH filter (DT). Before and after the filter was released, the distance between the metal cup and the longitudinal axis of IVC (ACM1,2) and the distance between the right side wall of the vena cava and the metal cup (DCM1,2) were measured. The IVC longitudinal axis and the filter longitudinal axis (ACF) and IVC diameter (DIVC) were also measured after each group was released. Results The tilt of each group of GTF distribution varies. In GRS, there was a significant difference between the number of cases in which the degree of filter inclination was grade III and the corresponding number in GLS (59% vs 36%, P = 0.003). Most of the differences between the two groups were statistically significant. There was a significant positive correlation between ACM1 and ACF, ACM1-ACM2 and DCH1-DCH2 in both groups. There was a significant negative correlation between DCH1 and ACF in both groups. Conclusions The tilt angle between the filter and IVC before release is the main reason for the tilt after GTV implantation.