下腔静脉滤器回收后血管形态改变的CT静脉造影研究

doi:10.3760/cma.j.cn101202-20190830-00271

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摘要目的探讨下腔静脉滤器回收后肾下段下腔静脉CT静脉造影(CTV)血管壁形态的改变,并分析相关影响因素。方法回顾性研究。纳入2015年1月—2018年2月在北京积水潭医院血管外科下腔静脉滤器回收后规范抗凝治疗70例患者的下腔静脉CTV图像为滤器组,男34例、女36例,年龄17~79(48.11±13.86)岁;在北京积水潭医院下腔静脉CTV数据库中随机抽取40例非血栓性疾病患者为对照组,男23例、女17例,年龄18~70(46.70±12.16)岁。在下腔静脉CTV图像上测量并比较两组下腔静脉最小直径和肾静脉开口下方1 cm平面参考直径的差异;观察滤器组肾下段下腔静脉壁有无增厚,应用logistic回归分析其影响因素。结果两组患者的性别、年龄差异均无统计学意义(P值均＞0.05)。滤器组和对照组下腔静脉参考直径分别为(16.0±2.6)、(20.2±2.4) mm,最小直径分别为(13.0±3.6)、(19.3±2.3)mm,差异均有统计学意义(t=8.267、10.032,P值均＜0.01)。滤器组35.7%(25/70)的患者血管壁局限性或环状增厚,下腔静脉最小直径为(10.3±3.6)mm; 64.3%(45/70)患者没有血管壁增厚,下腔静脉最小直径为(14.5±2.5)mm,差异有统计学意义(t=5.330, P＜0.01)。血管壁增厚患者与无增厚患者的下腔静脉血栓形成、下腔静脉参考直径差异均有统计学意义(χ²=6.459, t=3.794, P值均＜0.05);logistic多因素分析显示,下腔静脉血栓形成和下腔静脉参考直径是下腔静脉壁增厚的独立影响因素(OR=5.410、1.500,P值均＜0.01)。结论滤器回收后下腔静脉会出现不同程度的狭窄和血管壁增厚,下腔静脉血栓形成和较小的下腔静脉参考直径明显增加下腔静脉壁增厚的风险。

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	程志远
	贾伟
	田轩
	蒋鹏
	张蕴鑫
	李金勇
	田晨阳
	刘建龙

关键词 ：腔静脉滤器, 下肢深静脉血栓, 腔静脉,下, 静脉造影术, 体层摄影术,X线计算机

Abstract：Objective This study aimed to investigate the diameter and wall thickness of infrarenal vena cava after inferior vena cava filter retrieval on the basis of computed tomography venography (CTV) images and explore the related risk factors.Methods CTV images of the infrarenal vena cava of 70 patients, including 34 males and 36 females aged 17-79 (48.11±13.86) years who were admitted at Beijing Jishuitan Hospital from January 2015 to February 2018 and treated with anticoagulation after inferior vena cava filter retrieval, were retrospectively analyzed as the filter group. The CTV images of 40 patients, including 23 males and 17 females, aged 18-70 (56.1±10.36) years, with nonthrombotic diseases were randomly selected from the database as the control group. The diameters of the narrowest plane and that of the 1 cm plane below the renal vena cava orifice of the two groups were measured and compared. The thickness of the infrarenal vena cava wall was observed from the CTV images.Results No significant difference was observed in terms of gender and age between the two groups (P>0.05). The reference diameters of inferior vena cava in the filter group and the control group were (16.0±2.6) and (20.2±2.4) mm, respectively, and the minimum diameters were (13.0±3.6) and (19.3±2.3), respectively. The difference between the two groups was statistically significant(t=8.267 and 10.032, respectively; all P values＜0.01). The CTV images of 25 patients (35.7%) showed localized or annular wall thickening after inferior vena cava filter retrieval, and the minimum diameter of inferior vena cava was (10.3±3.6) mm; 45 patients (64.3%) did not exhibit inferior vena cava wall thickening, and the minimum diameter of inferior vena cava was (14.5±2.5) mm.There was difference statistically significant between the two groups (t=5.330, P<0.01). Significant differences were found in terms of inferior vena cava thrombosis and vascular diameter between the patients with and without vascular wall thickening (χ²=6.459, t=3.794, all P values<0.05). Logistic multivariate regression analysis showed that inferior vena cava thrombosis and inferior vena cava diameter were the independent risk factors for vascular wall thickening (OR=5.410 and 1.500, respectively; all P values<0.01).Conclusions CTV images can show annular or localized thickening and stenosis of inferior vena cava after filter retrieval. Thrombosis and small inferior vena cava diameter can considerably increase the risk of inferior vena cava wall thickening.

Key words： Vena cava filters Deep venous thrombus Vena cave, inferior Phlebography Tomography, X-ray computer

收稿日期: 2019-08-30

通讯作者: 刘建龙,Email:ljl_hy88@sina.com

引用本文:

程志远, 贾伟, 田轩, 蒋鹏, 张蕴鑫, 李金勇, 田晨阳, 刘建龙. 下腔静脉滤器回收后血管形态改变的CT静脉造影研究[J]. 中华解剖与临床杂志, 2020, 25(3): 272-277.
Cheng Zhiyuan, Jia Wei, Tian Xuan, Jiang Peng, Zhang Yunxin, Li Jinyong, Tian Chenyang, Liu Jianlong. CT venography study on vascular morphological changes after inferior vena cava filter retrieval. Chinese Journal of Anatomy and Clinics, 2020, 25(3): 272-277.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190830-00271 或 http://www.cjac.com.cn/CN/Y2020/V25/I3/272

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