Schuster Rob, Hagedorn Judith C, Curet Myriam J, Morton John M
Department of Surgery, Stanford University School of Medicine, Sanford, CA 94305, USA.
Surg Endosc. 2007 Dec;21(12):2277-9. doi: 10.1007/s00464-007-9370-1. Epub 2007 Apr 13.
Pulmonary embolus (PE) is a potentially devastating and fatal postoperative complication in morbidly obese patients. This study was undertaken to review the safety and efficacy of retrievable prophylactic inferior vena cava (IVC) filters in high-risk morbidly obese patients undergoing gastric bypass.
Patients who underwent gastric bypass surgery and preoperative insertion of retrievable IVC filters had their records reviewed. Indications for IVC filter insertion were: history of deep venous thrombosis (DVT) or PE, long-standing sleep apnea, venous stasis disease, and/or weight > 400 pounds.
24 patients underwent IVC filter placement before gastric bypass surgery. There were 10 women and 14 men with an average age of 50 +/- 6.3 years (range 39 to 59) and average body mass index (BMI) of 57 +/- 7.5 kg/m(2) (range 49 to 74). BMI greater then 50 kg/m(2) was present in 21 of 24 patients (88%). All patients had successful IVC filter placement. IVC filter retrieval postoperatively was performed in 20 of 24 patients (83%) with three left for clinical reasons and one (4%) left due to technical inability to retrieve. There was one complication directly attributable to IVC filter retrieval. There were no deaths. Five patients (21%) developed DVT or PE postoperatively. Follow-up was 16 +/- 7.6 months (range 8 to 33).
Prophylactic IVC filter placement and retrieval can be safely undertaken in high-risk gastric bypass patients. We recommend preoperative IVC filter placement in selected patients.
肺栓塞（PE）是病态肥胖患者术后一种潜在的毁灭性和致命性并发症。本研究旨在回顾可取出的预防性下腔静脉（IVC）滤器在接受胃旁路手术的高危病态肥胖患者中的安全性和有效性。
对接受胃旁路手术并术前插入可取出IVC滤器的患者的记录进行回顾。IVC滤器插入的指征为：深静脉血栓形成（DVT）或PE病史、长期睡眠呼吸暂停、静脉淤滞疾病和/或体重>400磅。
24例患者在胃旁路手术前放置了IVC滤器。其中10例女性，14例男性，平均年龄50±6.3岁（范围39至59岁），平均体重指数（BMI）为57±7.5kg/m²（范围49至74）。24例患者中有21例（88%）BMI大于50kg/m²。所有患者IVC滤器放置均成功。24例患者中有20例（83%）术后进行了IVC滤器取出，3例因临床原因未取出，1例（4%）因技术原因无法取出。有1例并发症直接归因于IVC滤器取出。无死亡病例。5例患者（21%）术后发生DVT或PE。随访时间为16±7.6个月（范围8至33个月）。
高危胃旁路手术患者可安全地进行预防性IVC滤器的放置和取出。我们建议在选定患者中术前放置IVC滤器。
