山东半岛成人肾下下腔静脉直径与长度测量及其意义

Objective To measure the diameter and length of infrarenal inferior vena cava (IVC)in Shandong Peninsula adult through digital subtraction angiography ( DSA) for better vena cava filter (VCF) choice and placement. Methods From April 2008 to June 2010, 83 discontinuous patients (49 males and 34 females, mean age 56. 4 years) with deep venous thrombosis ( DVT) of lower extremity were placed VCF through DSA according to ACCP-8. During operation, diameter and length of infrarenal IVC were measured. At the same time, the renal vein location and the type of the IVC were identified to help the VCF choice. Results All the VCFs were placed successfully, no complications occurred. The diameter of infrarenal IVC was 10 to 26 mm with a mean of (19 ±5) mm. The average length from beginning of IVC to the lower renal vein was (10. 6 ±2. 8) cm. The renal vein was located between the first and second lumbar vertebra, the IVC beginning was located between the fourth and fifth lumbar vertebra. Conclusions Diameter and length measurement of infrarenal IVC is helpful to the VCF selection and the domestic VCF research. Vena cava angiography is very important to the accurate placement of VCF.     

山东半岛成人肾下下腔静脉直径与长度测量及其意义

Objective To measure the diameter and length of infrarenal inferior vena cava (IVC)in Shandong Peninsula adult through digital subtraction angiography ( DSA) for better vena cava filter (VCF) choice and placement. Methods From April 2008 to June 2010, 83 discontinuous patients (49 males and 34 females, mean age 56. 4 years) with deep venous thrombosis ( DVT) of lower extremity were placed VCF through DSA according to ACCP-8. During operation, diameter and length of infrarenal IVC were measured. At the same time, the renal vein location and the type of the IVC were identified to help the VCF choice. Results All the VCFs were placed successfully, no complications occurred. The diameter of infrarenal IVC was 10 to 26 mm with a mean of (19 ±5) mm. The average length from beginning of IVC to the lower renal vein was (10. 6 ±2. 8) cm. The renal vein was located between the first and second lumbar vertebra, the IVC beginning was located between the fourth and fifth lumbar vertebra. Conclusions Diameter and length measurement of infrarenal IVC is helpful to the VCF selection and the domestic VCF research. Vena cava angiography is very important to the accurate placement of VCF.     

山东半岛成人肾下下腔静脉直径与长度测量及其意义

Objective To measure the diameter and length of infrarenal inferior vena cava (IVC)in Shandong Peninsula adult through digital subtraction angiography ( DSA) for better vena cava filter (VCF) choice and placement. Methods From April 2008 to June 2010, 83 discontinuous patients (49 males and 34 females, mean age 56. 4 years) with deep venous thrombosis ( DVT) of lower extremity were placed VCF through DSA according to ACCP-8. During operation, diameter and length of infrarenal IVC were measured. At the same time, the renal vein location and the type of the IVC were identified to help the VCF choice. Results All the VCFs were placed successfully, no complications occurred. The diameter of infrarenal IVC was 10 to 26 mm with a mean of (19 ±5) mm. The average length from beginning of IVC to the lower renal vein was (10. 6 ±2. 8) cm. The renal vein was located between the first and second lumbar vertebra, the IVC beginning was located between the fourth and fifth lumbar vertebra. Conclusions Diameter and length measurement of infrarenal IVC is helpful to the VCF selection and the domestic VCF research. Vena cava angiography is very important to the accurate placement of VCF.     

AngioJet血栓清除术治疗存在溶栓禁忌证的急性下肢深静脉血栓

目的观察AngioJet血栓清除术对存在溶栓禁忌证的急性下肢深静脉血栓形成(LEDVT)的治疗效果。方法对18例存在溶栓禁忌证的急性LEDVT患者先行下腔静脉滤器置入术,而后行AngioJet血栓清除术;对合并髂静脉闭塞患者行髂静脉成形术。术后随访,观察治疗效果及安全性。结果18例均一次性治疗成功,血栓均完全清除;12例合并左髂静脉闭塞,均成功行血管成形术;18例患侧下肢静脉血流均恢复通畅。术后16例出现血红蛋白尿,无出血、肺栓塞等并发症。对16例随访3~37个月,13例下肢静脉血流通畅,3例血栓复发。结论采用AngioJet血栓清除术治疗存在溶栓禁忌证的LEDVT患者临床疗效较好。     

CT指导介入治疗下腔静脉Budd-Chiari综合征

目的评估CT对下腔静脉型Budd-Chiari综合征(BCS)介入治疗的临床指导价值。方法收集于我院接受介入治疗的329例下腔静脉型BCS患者,所有患者术前均接受CT检查,并根据CT诊断结果制定介入治疗方案。以DSA治疗结果为金标准,评估CT诊断的准确率、敏感度、特异度、阳性预测值和阴性预测值。结果 DSA示下腔静脉不完全闭塞型BCS 108例,下腔静脉完全闭塞型221例;CT诊断下腔静脉不完全闭塞型99例,下腔静脉完全闭塞型230例。与DSA结果相比,CT诊断15例假阴性,6例假阳性。CT术前制定是否破膜的准确率、敏感度、特异度、阳性预测值及阴性预测值分别为94.19%、97.29%、86.11%、93.49%及93.94%,CT术前制定介入治疗方法的准确率、敏感度、特异度、阳性预测值及阴性预测值分别为97.55%、100%、92.52%、96.49%和100%。结论 CT诊断下腔静脉型BCS准确率较高,且有助于制定介入治疗方案。     

AngioJet机械血栓清除术治疗外科手术后急性下肢深静脉血栓

目的 观察AngioJet经皮机械血栓清除术（PMT）治疗外科手术后急性下肢深静脉血栓（DVT）的效果。方法 回顾性分析103例接受AngioJet PMT治疗的外科手术后急性下肢DVT患者,对比术前与术后7天大腿和小腿患-健侧周径差及外周血D-二聚体水平,检测下肢静脉各段血栓清除率,记录术中及术后不良反应。结果 PMT后7天,大腿和小腿患-健侧周径差均较术前减小（P均<0.05）,外周血D-二聚体较术前下降（P<0.05）;下肢静脉髂段、股段及腘段有效（Ⅱ、Ⅲ级）血栓清除率分别为97.37%（74/76）、98.06%（101/103）及94.83%（55/58）,Ⅲ级血栓清除率分别为77.63%（59/76）、70.87%（73/103）和55.17%（32/58）,髂段、股段Ⅲ级血栓清除率均高于腘段（P均<0.01）。血栓清除术中11例（11/103,10.68%）出现一过性心律失常,均于停止吸栓操作2 min内恢复正常。术后3例发生穿刺点出血,一过性血红蛋白尿38例,一过性肌酐升高2例,患肢疼痛3例;未见新发肺栓塞和急性肾衰竭。2例滤器未取出;6例取出滤器内见明显血栓。结论 AngioJet机械血栓清除术治疗急性下肢DVT效果较好且安全。     

下腔静脉滤器致腰动脉医源性刺破1例

<正>患者女,57岁,因"反复胸闷、气促4月余,加重8天"入院。查体:呼吸加快,双侧腓肠肌轻压痛。实验室检查:血红蛋白136 g/L,D-二聚体1.85 μg/ml。肺动脉CTA:双肺动脉分支多发栓塞。下肢静脉超声:双小腿肌间静脉扩张伴实性回声,考虑血栓形成。临床诊断:下肢静脉血栓形成+肺栓塞。行下腔静脉滤器置入+置管溶栓术,后予尿激酶溶栓(25万U/8 h)+低分子肝素抗凝(5 000 U/12 h)。术后第2天晚间患者诉右下腹闷痛伴腰背酸     

三维DSA显示子宫动脉开口

目的探讨三维DSA显示子宫动脉(UA)开口位置的价值。方法选择90例接受子宫动脉栓塞术患者,经导管分别选择入左、右髂内动脉,行三维DSA血管造影,然后对图像进行三维后处理,每间隔5°旋转,采集三维图像,观察UA最佳显示角度范围;统计UA起源及开口角度,以臀上动脉开口为定位点,测量UA开口距臀上动脉开口距离。结果在对侧斜位和同侧斜位30°~60°显示UA开口最好;116支(116/180,64.44%)UA起源于髂内动脉前干;33支(33/180,18.33%)起源于臀下阴部干;17支(17/180,9.44%)起源于阴部内动脉;10支(10/180,5.56%)起源于髂内动脉主干;4支(4/180,2.22%)起源于臀上动脉。UA与起源动脉夹角0~30°为19支,占10.56%(19/180);30°~60°70支,占38.89%(70/180);60°~90°74支,占41.11%(74/180);90°~120°8支,占4.44%(8/180);120°~150°5支,占2.78%(5/180);150°~180°4支,占2.22%(4/180)。UA开口至臀上动脉开口距离为3.04~18.31mm,平均(11.71±4.28)mm。结论三维DSA可较好地显示子宫动脉起源、开口角度以及距臀上动脉的距离。     

在DSA下介入性栓塞治疗肾错构瘤9例报告

在数字减影血管造影条件下采用Ｓｅｌｄｉｎｇｅｒ技术对９例肾错构瘤患者进行超选择介入治疗，即在明确病变部位供血动脉后，超选择将导和尖端置入靶血管，最后给予无水乙醇及明胶海绵进行介入性栓塞治疗，使错构瘤组织完全灭活坏死。     

下腔静脉滤器断裂1例

正孕患者女,38岁,主因"转移性右下腹痛2天,右下肢肿胀1天"入院。患者14年前因左下肢深静脉血栓形成(deep venous thrombosis,DVT)于外院接受下腔静脉滤器置入术及左髂静脉支架置入术。体查:体温37.5℃;右下肢较左下肢增粗,右侧膝上10cm及膝下10cm处腿围分别为44.81cm和35.18cm,左侧分别为41.50cm和33.04cm,且右下肢皮肤张力较左侧增高,右下肢Homans征及Neuhof征阳性;右下腹麦氏点有压痛、反跳痛及     

原发性下腔静脉平滑肌肉瘤的诊治体会

目的 探讨原发性下腔静脉平滑肌肉瘤的临床特点和诊治方法.方法 回顾性分析2006年6月至2009年4月收治的7例原发性下腔静脉平滑肌肉瘤的临床资料,包括临床表现、手术方法、病理结果和预后.结果 3例完整切除肿瘤,其中2例下腔静脉管壁缺损应用人工血管进行修补;1例切除部分肿瘤,恢复肝静脉血流;3例行剖腹探查肿瘤活检,明确诊断后放弃手术.7例术后病理均为原发性下腔静脉平滑肌肉瘤,3例雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)呈阳性,4例呈阴性.无围手术期死亡病例,3例完整切除肿瘤者术后预防性口服华法林抗凝6个月,分别随访8、32、33个月,未发现肿瘤复发和血栓形成;1例部分切除者存活2个月,死于肝功能衰竭;3例只行肿瘤活检者均于7个月内死亡.结论 完整切除肿瘤和必要的下腔静脉重建是治疗原发性下腔静脉平滑肌肉瘤的惟一有效方法.     

原发性下腔静脉平滑肌肉瘤1例

<正>患者女,55岁,因"无明显诱因出现腹部包块2年余"入院。查体:下腹部触及约15cm×15cm×20cm肿物,活动性欠佳,无明显压痛、反跳痛及肌紧张。CT:右侧腹膜后见团块状浅分叶型软组织密度影,约18.1cm×10.4cm×8.6cm,CT值约9~70HU,边缘尚清,增强扫描病灶呈不均匀延迟强化,内见     

肝癌合并下腔静脉癌栓的外科治疗

目的总结7例肝癌合并下腔静脉（inferior vena cava,IVC）癌栓患者的手术方法及治疗经验。方法自2003年7月至2005年5月,我们为7例肝癌合并IVC癌栓的患者实施了肝癌切除及右心房和（或）IVC切开取栓手术。所有患者均采用全肝血流阻断来控制IVC血流。根据癌栓上极位置的不同,分别采用5种不同术式：（1）静脉转流,心脏停搏,右心房及下腔静脉切开取栓1例;（2）静脉转流,心脏不停搏,心包内高位阻断下腔静脉,右心房和（或）下腔静脉切开取栓2例;（3）经腹部切口切开膈肌,心包内高位阻断下腔静脉,下腔静脉切开取栓1例;（4）经腹部切口,经膈肌腔静脉裂孔小切口,心包外高位阻断肝上下腔静脉,下腔静脉切开取栓1例;（5）经腹部切口,肝上阻断下腔静脉,下腔静脉切开取栓2例。结果所有手术均获成功,术后并发症包括胸腔积液2例,右膈下积液1例,切口感染1例。7例患者的生存时间为2周～26个月,平均9．8个月。已死亡的6例患者术后生存时间分别为13、9、11、2、17个月和2周,尚生存的1例患者已无瘤生存26个月。结论对合适病例实施肝癌切除和IVC切开取栓手术是安全可行的。手术治疗可以避免右心流人道阻塞和肺动脉栓塞造成的猝死,并有可能获得相对提高的生存时间和生活质量。     

经股腘静脉抽吸治疗下肢深静脉继发下腔静脉血栓

目的探讨经股静脉入路放置滤器治疗继发于下肢深静脉血栓(DVT)的下腔静脉血栓的可行性及安全性,评价滤器保护下血栓抽吸术的有效性。方法收集109例下肢DVT患者,其中11例血栓累及下腔静脉。于路径图引导下经健侧股静脉入路放置Aegisy滤器,打开但不解脱;再次穿刺股静脉,以8F指引导管抽吸下腔静脉内血栓;若血栓脱落于滤器内,尽量取出滤器内血栓后收回滤器,清洗后重新放置。经腘静脉入路抽吸髂股静脉内血栓,应用球囊或支架治疗髂静脉病变。14天内取出滤器。结果对11例DVT合并下腔静脉血栓者均成功取出髂股静脉及下腔静脉内血栓,8例术中发生血栓脱落;置入髂静脉支架5例,球囊扩张6例;8例取出滤器,3例永久植入滤器。随访6~35个月,下腔静脉及支架通畅,患者无活动后酸沉、肿胀,无色素沉着、静脉曲张等。结论经股静脉放置滤器治疗DVT合并下腔静脉血栓安全可行;在滤器保护下应用血栓抽吸术经股腘静脉入路治疗血栓快速、有效。     

下腔静脉血栓形成诊断及介入治疗进展

下腔静脉血栓是一种少见疾病,其所有致病因素均可归属于血液淤滞状态、血管损伤及血液高凝状态;患者的症状和体征随病因不同而有差异,从无症状到心血管系统衰竭均有可能,因而治疗方案有别,包括抗凝、外科开放手术及腔内介入治疗等。本文就下腔静脉血栓的病因、临床表现、诊断及介入治疗等方面的研究进展进行综述。     

肝脏巨大血管瘤行肝静脉与下腔静脉阻断的临床效果分析

目的探讨肝静脉肝外阻断在近第二肝门肝脏巨大血管瘤治疗中的应用。方法回顾性分析2012年2月至2014年5月收治的32例肝门肝脏巨大血管瘤患者的临床资料,根据治疗方法分为肝静脉阻断(HVE组14例)与下腔静脉阻断(IVE组18例)。记录两组患者术中情况、术后情况及并发症情况差异。在SPSS 10.0中进行统计分析,术中指标;术后第1、3、7天的生化指标以(x珋±s)表示,采用两样本独立t检验,两组间并发症率比较采用卡方检验,检验水准取α=0.05。结果 HVE组的手术时间、术中出血量、输血量、术后引流量均显著的低于IVE组(t=3.005、t=8.187、t=17.411、t=6.958,P0.05)。IVE组的总胆红素(TBIL)在术后3 d显著高于HVE组(t=3.024,P=0.012);IVE组的ALT、AST在术后第1天显著高于HVE组(t=2.673、t=2.801、P0.05)差异均有统计学意义。术后并发症HVE组为2例(14.29%)显著低于IVE组的9例(50.00%)(χ2=4.453,P=0.035)。结论相对于IVE技术,HVE技术的术中创伤更小,术后肝功能恢复更快,并发症发生率更低。