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肺动脉栓塞是急性下肢深静脉血栓(deep venous thrombosis, DVT)的临床常见并发症,可造成致命性伤害,近年来发病率呈上升趋势[1-4]。下腔静脉滤器(vena cava filter,VCF)可以有效地预防肺栓塞的发生,最常用的手术方法是DSA下放置下腔静脉滤器,而超声引导下行下腔静脉滤器亦作为一种手术方式,逐渐成为DSA下放置腔静脉滤器的有益补充,以其独特优势,在临床上逐渐获得重视和推广。我院血管外科在超声引导下放置下腔静脉滤器21例,取得了良好的效果。现作报道。
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2组手术成功率差异无统计学意义(P>0.05),超声引导组住院时间、住院费用、手术时间均低于DSA引导组(P<0.05~P<0.01)。超声引导组发现1例滤器倾斜,DSA引导组9例,倾斜角度均小于20°,2组差异无统计学意义(P>0.05)(见表 1)。
分组 n 住院时间/d 住院费用/元 手术时间/min 滤器倾斜率 手术成功率 超声引导组 21 12.65±1.32 21 326±662.8 18.82±2.01 1(4.76) 21(100) DSA引导组 182 13.18±1.12 26 571±706.3 28.33±2.45 9(4.94) 180(98.90) t — 2.01 32.42 17.12 0.25△ — P — <0.05 <0.01 <0.01 > 0.05 > 0.05□ △示校正χ2值;□示Fisher′s确切概率法 表 1 2组住院时间、住院费用、手术时间、滤器倾斜率及手术成功率比较(x±s)
超声引导组14例左下肢深静脉血栓形成病人经右侧股静脉置入,7例右下肢深静脉形成病人左侧股静脉置入。术后即刻超声显示VCF均位于下腔静脉内肾静脉开口处至双髂静脉汇合处之间,滤器张开完全、无变形。CDFI血流通过良好,肾静脉血流汇入通畅。DSA引导组右侧肢体DVT 20例,经左侧股静脉穿刺置入VCF,左侧肢体DVT 160例,经右侧股静脉穿刺置入VCF;2例失败,1例严重肥胖病人,穿刺时形成动静脉瘘而停止手术,1例为下腔静脉闭塞而停止手术。2组均无穿刺点红肿、血肿形成及穿刺血管血栓形成。经抗凝祛聚等治疗后病人临床症状缓解,患肢肿胀消退。随访期间无VCF相关并发症,2组均无术后发生肺栓塞,无死亡病例,无VCF脱落及移位情况出现,2组差异无统计学意义(χ2=1.32,P>0.05)。
超声引导下腔静脉滤器置入及临床应用的可行性研究
Feasibility study on ultrasound-guided vena cava filter implantation and its clinical application
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摘要:
目的探讨彩色超声引导下行下腔静脉滤器(VCF)置入术的可行性、安全性和临床实用价值。 方法收集行VCF置入术的203例病人资料,其中21例在彩色超声引导下放置VCF(超声引导组),182例在DSA下放置VCF(DSA引导组),比较2组住院时间、住院费用、手术时间、滤器倾斜率、手术成功率及随访期间VCF相关并发症。 结果2组手术成功率、滤器倾斜率差异均无统计学意义(P>0.05)。超声引导组住院时间、住院费用、手术时间均低于DSA引导组(P < 0.05~P < 0.01)。术后随访3~6个月均未出现VCF相关并发症。 结论超声引导和DSA引导VCF置入均有很好的安全性及可行性,彩色多普勒超声引导对于造影剂过敏、肾功能不全及搬动困难者更适宜,值得临床推广。 Abstract:ObjectiveTo explore the feasibility, safety and clinical value of vena cava filter (VCF) implantation under the guidance of color ultrasound. MethodsThe data of 203 patients undergoing vena cava filter (VCF) implantation were collected.Among them, twenty-one patients were placed VCF under the guidance of color ultrasound (ultrasound-guided group), and 182 patients were placed VCF under the guidance of DSA (DSA-guided group).The hospitalization time, hospitalization cost, operation time, filter tilt rate, operation success rate, and VCF-related complications during follow-up were compared between the two groups. ResultsThere was no significant difference in the success rate and filter tilt rate between the two groups (P>0.05).The hospitalization time, hospitalization cost and operation time in ultrasound-guided group were lower than those in DSA-guided group (P < 0.05 to P < 0.01).There was no VCF-related complications during the follow-up of 3 to 6 months. ConclusionsBoth ultrasound-guided and DSA-guided VCF implantation have good safety and feasibility.Color Doppler ultrasound guidance is more suitable for patients with contrast medium allergy, renal insufficiency and difficulty in moving, which is worthy of clinical promotion. -
Key words:
- deep venous thrombosis /
- vena cava filter /
- pulmonary embolism /
- color Doppler ultrasound
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表 1 2组住院时间、住院费用、手术时间、滤器倾斜率及手术成功率比较(x±s)
分组 n 住院时间/d 住院费用/元 手术时间/min 滤器倾斜率 手术成功率 超声引导组 21 12.65±1.32 21 326±662.8 18.82±2.01 1(4.76) 21(100) DSA引导组 182 13.18±1.12 26 571±706.3 28.33±2.45 9(4.94) 180(98.90) t — 2.01 32.42 17.12 0.25△ — P — <0.05 <0.01 <0.01 > 0.05 > 0.05□ △示校正χ2值;□示Fisher′s确切概率法 -
[1] 张福先, 李晓强, 刘建龙, 等.腔静脉滤器临床应用指南[J].中国实用外科杂志, 2019, 39(7):651. [2] 张福先.腔静脉滤器的规范性应用与并发症的预防[J].中国普外基础与临床杂志, 2020, 27(4):396. [3] NAKAGAWA Y, INOKUCHI S, TSUJI T, et al.The efficacy of early anticoagulant therapy for venous thromboembolism in polytrauma patients in The acute phase[J].Tokai J Exp Clin Med, 2012, 37(4):121. [4] SEKHRI V, MEHTA N, RAWAT N, et al.Management of massive and nonmassive pulmonary embolism[J].Arch Med Sci, 2012, 8(6):957. [5] KONSTANTINIDES SV, MEYER G, BECATTINI C, et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society(ERS):The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)[J].Eur Respir J, 2019, 54(3):138. [6] MCGREGOR H, WOODHEAD G, HENNEMEYER C, et al.Percutaneous translumbar inferior vena cava filter retrieval[J].J Vasc Interv Radiol, 2020, 31(4):690. doi: 10.1016/j.jvir.2019.10.018 [7] SHAIKH SS, KAMATH SD, GHOSH D, et al.Safety and outcomes of permanent and retrievable inferior vena cava filters in the oncology population[J].Intern J Vasc Med, 2020, 20(2):658. [8] DICKERSON JC, HARRIEL KL, DAMBRINO RJ, et al.Screening duplex ultrasonography in neurosurgery patients does not correlate with a reduction in pulmonary embolism rate or decreased mortality[J].J Neurosurg, 2020, 132(5):1589. doi: 10.3171/2018.12.JNS182800 [9] 郭文城, 余波, 史伟浩.外科住院病人并发下肢深静脉血栓高危因素及诊治进展[J].中国实用外科杂志, 2020, 10(5):594. [10] 康睿, 吴茂林, 靳莉, 等.超声介入在下肢深静脉血栓治疗的临床研究[J].双足与保健, 2019(24):94. [11] 冯超, 陈超.超声介入在下肢深静脉血栓治疗的临床研究[J].实用医院临床杂志, 2019, 16(2):35. [12] 安鹏, 尹家保, 杨浩, 等.彩色多普勒超声床旁引导下腔静脉滤器植入的可行性研究[J].中国临床医学影像杂志, 2018, 29(2):139. [13] 葛志通, 李建初.超声介入治疗在血管疾病中的应用[J].协和医学杂志, 2020, 11(1):62. [14] 梁刚, 陈朴一, 王彬, 等.彩色多普勒超声在下肢静脉漂浮血栓诊疗中的价值[J].中国医药科学, 2019, 9(21):13. [15] 符伟国, 史振宇.重视普通外科围手术期静脉血栓栓塞症规范化防治[J].中国实用外科杂志, 2020, 40(5):503. [16] 李金勇, 刘建龙, 贾伟, 等.急性下腔静脉滤器内血栓个体化治疗策略分析[J].临床军医杂志, 2019, 47(12):1376. [17] 李凯平, 刘智平.下腔静脉滤器置入远期并发症及随访管理的研究进展[J].护理研究, 2019, 33(24):4252. [18] 慈红波, 阿力木江·沙吾提, 郭军, 等.下腔静脉滤器的临床应用分析[J].国际外科学杂志, 2019, 46(11):749.