Halmi Denis, Kolesnikov Evgeni
Virginia Weight Loss Surgery Center, Potomac Hospital, Woodbridge, Virginia, USA.
Surg Obes Relat Dis. 2007 Nov-Dec;3(6):602-5. doi: 10.1016/j.soard.2007.04.004. Epub 2007 Jun 4.
Postoperative pulmonary embolism (PE) is a major source of mortality after bariatric surgery. In conjunction with pharmacologic thromboprophylaxis, lower extremity pneumatic compression devices, and early ambulation, preoperative placement of a retrievable inferior vena cava (IVC) filter may reduce the risk of thromboembolic complications.
From June 2003 to October 2005, 652 patients underwent mini-open Roux-en-Y gastric bypass. Of the 652 patients, 557 were women and 95 were men. The mean patient age was 40.7 +/- 3.6 years (range 18-67), mean body mass index was 44.7 +/- 4.6 kg/m(2) (range 35-78), and mean operative time was 60.2 +/- 5.3 minutes (range 42-79). The high-risk PE group consisted of 27 patients (4.1%; 9 men and 18 women) who received preoperative retrievable IVC filters placed by the interventional radiology staff 2 hours before bypass surgery. Their mean age was 47 +/- 4.4 years (range 31-66) and mean body mass index 48.7 +/- 4.2 kg/m(2) (range 38-75). The indications for filter placement were previous deep vein thrombosis/PE, thrombophlebitis, a hypercoagulable state, pulmonary hypertension, an inability to ambulate, a body mass index >65 kg/m(2), and the presence of severe sleep apnea. The filters were removed 18.2 +/- 2 days (range 15-21) postoperatively.
All 27 patients who received a prophylactic IVC filter tolerated the procedure well, without major complications. One retrievable filter was not removed because of prolonged hospitalization secondary to small bowel obstruction. No thromboembolic complications occurred in this high-risk group.
Preoperative placement of retrievable IVC filters is a safe measure for the prophylaxis of PE in high-risk bariatric patients. The filters can be placed efficiently just before surgery, and most filters can be removed 2-3 weeks postoperatively. Additional investigation is necessary to prove the effectiveness of retrievable IVC filters in bariatric surgery.
术后肺栓塞（PE）是减重手术后死亡的主要原因。结合药物性血栓预防、下肢气动压迫装置和早期活动，术前放置可回收下腔静脉（IVC）滤器可能降低血栓栓塞并发症的风险。
2003年6月至2005年10月，652例患者接受了迷你开放式Roux-en-Y胃旁路手术。652例患者中，557例为女性，95例为男性。患者平均年龄为40.7±3.6岁（范围18 - 67岁），平均体重指数为44.7±4.6kg/m²（范围35 - 78），平均手术时间为60.2±5.3分钟（范围42 - 79）。高风险PE组由27例患者（4.1%；9例男性和18例女性）组成，他们在旁路手术前2小时由介入放射科工作人员放置了术前可回收IVC滤器。他们的平均年龄为47±4.4岁（范围31 - 66岁），平均体重指数为48.7±4.2kg/m²（范围38 - 75）。放置滤器的指征为既往深静脉血栓形成/PE、血栓性静脉炎、高凝状态、肺动脉高压、无法活动、体重指数>65kg/m²以及存在严重睡眠呼吸暂停。滤器在术后18.2±2天（范围15 - 21天）取出。
所有27例接受预防性IVC滤器的患者对该操作耐受性良好且无重大并发症。由于小肠梗阻导致住院时间延长，1个可回收滤器未取出。该高风险组未发生血栓栓塞并发症。
术前放置可回收IVC滤器是预防高风险减重患者发生PE的安全措施。滤器可在手术前有效放置，且大多数滤器可在术后2 - 3周取出。需要进一步研究以证实可回收IVC滤器在减重手术中的有效性。
