Application of Different Inferior Vena Cava Filters Placed in the Renal Vein for Endovascular Treatment of Deep Venous Thrombosis
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摘要:
目的 研究不同下腔静脉滤器（IVCF）肾静脉上置入在深静脉血栓（DVT）腔内治疗中的应用效果。 方法 选取云南省保山市第二人民医院2021年1月至2022年6月收治的102例行肾静脉上IVCF的下肢DVT患者，根据患者IVCF类型分为可回收组（n = 51）与永久性组（n = 51）。比较两组滤器置入情况、围术期肢体周径差、D-二聚体、纤维蛋白原、静脉再通评分、静脉再通率以及术后12个月并发症状况、无复发生存状况。 结果 两组手术成功率均为100%；两组术后1 d、3 d及7 d膝关节以上15 cm及以下10 cm周径差均较术前缩小，且均呈下降趋势（P < 0.05）；两组术后1 d、3 d及7 d D-二聚体及纤维蛋白原均较术前缩小，且均呈下降趋势（P < 0.05）；两组术后7 d静脉再通评分均较术前明显下降（P < 0.05）；可回收组术后并发症发生率较永久性组低（P < 0.05）。 结论 肾静脉上置入可回收型IVCF用于DVT腔内治疗效果明显，可调节下肢周径差，改善凝血功能，降低并发症发生率、复发率。 Abstract:Objective To study the application effects of different inferior vena cava filters （IVCF） placed in the renal vein for the treatment of deep vein thrombosis （DVT）. Methods A total of 102 patients with lower limb DVT who underwent renal vein IVCF at the Second People's Hospital of Baoshan from January 2021 to June 2022 were selected. According to the type of IVCF, patients were divided into a retrievable group （n = 51） and a permanent group （n = 51）. The two groups were compared in terms of filter placement conditions, perioperative limb circumference differences, D-dimer, fibrinogen, venous recanalization scores, venous recanalization rates, as well as complications and recurrence-free survival status 12 months post-operation. Results The surgical success rate was 100%. The differences in limb circumference above the knee （15 cm） and below the knee （10 cm） at 1 day, 3 days, and 7 days post-operation were significantly reduced compared to pre-operative measurements and showed a downward trend （P < 0.05）. D-dimer and fibrinogen levels at 1 day, 3 days, and 7 days post-operation were also significantly reduced compared to pre-operative levels, with a downward tren （P < 0.05）. The venous recanalization scores at 7 days post-operation were significantly lower than pre-operative scores in both groups （P < 0.05）. The incidence of postoperative complications in the retrievable group was lower than that in the permanent group （P < 0.05）. Conclusion The placement of a retrievable IVCF on the renal vein for endovascular treatment of DVT has significant therapeutic effects, can adjust the circumference difference of the lower limb, improve coagulation function, and reduce the incidence of complications and recurrence. -
Key words:
- Vein wall morphology /
- Pulmonary embolism /
- Retrievable /
- Venous filter /
- Deep vein thrombosis /
- Renal vein
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图 1 下腔静脉造影（可回收型下腔静脉滤器置入+左侧髂静脉支架置入术）
Figure 1. Inferior vena cava angiography （Placement of a retrievable inferior vena cava filter + left iliac vein stent placement）
表 1 两组一般资料比较[n（%）/（$ \bar x \pm s$）]
Table 1. Comparison of general information between two groups[n（%）/（$ \bar x \pm s$）]
一般资料 可回收组（n = 51） 永久性组（n = 51） t/χ2 P 性别 0.157 0.692 男 27（52.94） 25（49.02） 女 24（47.06） 26（50.98） 患肢分布 0.382 0.537 左肢 34（66.67） 31（60.78） 右肢 17（33.33） 20（39.22） 类型分布 0.413 0.814 混合型 33（64.71） 30（58.82） 中央型 8（15.69） 10（19.61） 外周型 10（19.61） 11（21.57） 患肢临床表现 肿胀 48（94.12） 46（90.20） 0.136 0.713 肤色瘀紫或变红 50（98.04） 47（92.16） 0.841 0.359 发病原因 0.562 0.905 外伤 22（43.14） 23（45.10） 外科手术 18（35.29） 16（31.37） 长期卧床 8（15.69） 10（19.61） 其他 3（5.88） 2（3.92） 吸烟史 37（72.55） 40（78.43） 0.477 0.490 饮酒史 35（68.63） 30（58.82） 1.060 0.303 年龄（岁） 38～65（51.49 ± 6.33） 40～64（52.03 ± 5.97） 0.443 0.659 体质量指数（kg/m2） 19.1～24.7（21.97 ± 1.28） 19.1～25.2（22.15 ± 1.44） 0.667 0.506 
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表 2 两组肢体周径差比较（$ \bar x \pm s $，cm）
Table 2. Comparison of limb circumference difference between the two groups （$ \bar x \pm s$，cm）
测量部位 组别 n 术前 术后1 d 术后3 d 术后7 d F p 膝关节以上15 cm 可回收组 51 6.94 ± 2.78 5.71 ± 1.74* 3.41 ± 1.02* 2.20 ± 0.66* 77.155 0.000 永久性组 51 6.85 ± 3.02 5.75 ± 1.80* 3.39 ± 1.10* 2.17 ± 0.58* 67.182 0.000 t 0.157 0.114 0.095 0.244 P 0.876 0.909 0.924 0.808 膝关节以下10 cm 可回收组 51 5.12 ± 1.56 4.32 ± 1.08* 2.40 ± 0.71* 1.67 ± 0.45* 123.092 0.000 永久性组 51 5.10 ± 1.61 4.29 ± 1.07* 2.38 ± 0.75* 1.65 ± 0.44* 117.698 0.000 t 0.064 0.141 0.138 0.227 P 0.949 0.888 0.890 0.821 *P < 0.05。
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表 3 两组D-二聚体及纤维蛋白原比较（$ \bar x \pm s$）
Table 3. Comparison of D-dimer and fibrinogen between the two groups （$\bar x \pm s $）
测量部位 组别 n 术前 术后1 d 术后3 d 术后7 d F P D-二聚体（mg/L） 可回收组 51 1.74 ± 0.22 1.35 ± 0.21* 0.90 ± 0.17* 0.50 ± 0.16* 402.484 0.000 永久性组 51 1.73 ± 0.26 1.34 ± 0.25* 0.92 ± 0.16* 0.54 ± 0.18* 287.861 0.000 t 0.210 0.219 0.612 1.186 P 0.834 0.827 0.542 0.238 纤维蛋白原（g/L） 可回收组 51 5.26 ± 1.14 4.47 ± 0.98* 3.78 ± 0.65* 1.64 ± 0.41* 172.848 0.000 永久性组 51 5.22 ± 1.07 4.52 ± 0.95* 3.74 ± 0.59* 1.62 ± 0.39* 194.538 0.000 t 0.183 0.262 0.325 0.252 P 0.855 0.794 0.746 0.801 *P < 0.05。
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表 4 两组静脉再通评分及静脉再通率（$ \bar x \pm s $）
Table 4. Venous recanalization scores and rates in the two groups （$ \bar x \pm s $）
组别 n 静脉再通评分（分） 静脉再通率（%） 术前 术后7 d t P 可回收组 51 7.24 ± 1.15 2.34 ± 0.58 27.169 < 0.001* 65.37 ± 18.23 永久性组 51 6.92 ± 1.36 2.29 ± 0.54 22.596 < 0.001* 66.13 ± 20.14 t 1.283 0.451 0.200 P 0.202 0.653 0.842
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表 5 两组术后并发症发生率比较[n（%）]
Table 5. Comparison of postoperative complication rates between two groups [n （%）]
组别 n 静脉阻塞 腰腹部疼痛 出血 肺栓塞 总发生率 可回收组 51 0（0.00） 2（3.92） 1（1.96） 0（0.00） 3（5.88） 永久性组 51 2（3.92） 5（9.80） 3（5.88） 1（1.96） 11（21.57） χ2 − 0.614 0.260 − 5.299 P 0.495 0..434 0.610 1.000 0.021* “−”为用确切概率法计算，无χ2值；*P < 0.05。
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