医源性血管内异物介入取出6例的初步经验  

The preliminary experience of percutaneous endovascular retrieval for iatrogenic foreign body in 6 patients

作　　者：肖亮[1] 申景[1] 解世洋[2] 魏东升[3] 

机构地区：[1]中国医科大学附属第一医院,110001 [2]中国医科大学 [3]内蒙古自治区通辽市医院

出　　处：《山西医药杂志（上半月）》2011年第5期432-434,共3页Shanxi Medical Journal

基　　金：国家十一五科技支撑计划项目(2007BAI05B04)

摘　　要：目的探讨介入方法清除医源性血管内异物的操作技巧及安全性。方法 2005年10月至2009年10月于我院就治的血管内异物介入取出术的6例患者,6次操作,男性4例,女性2例,年龄22～69岁,平均47.3岁。2例中心静脉留置导管(PICC)落入肺动脉、1例腔静脉滤器未张开、1例鹅颈捕捉器头端断裂、1例支架推送器前端断裂及1例滤器回收钩断裂,采用弯猪尾导管、长鞘、鹅颈捕捉器、异物钳行异物取出术。结果 6例患者均成功取出异物,总成功率达100%(6/6)。2例采用猪尾导管及导丝袢成功取出断裂的PICC管,1例采用鹅颈捕捉器将下腔静脉内未张开的滤器移至股静脉,局部静脉剖开取出异物,1例采用异物钳成功取出滤器及断裂的鹅颈捕捉器,1例采用长鞘负压回吸的方法将腘动脉内的支架推送器断裂成功取出,1例因滤器回收钩断裂而放弃滤器取出。术中及术后未出现介入操作相关的并发症。结论经皮血管内异物取出术可以及时、有效地解决异物残留血管的难题,还具有创伤小、安全性高的优点,可以作为临床处理血管内异物的首选措施。Objective To evaluate the operative technique and safety of percutaneous endovascular retrieval for iatrogenic foreign body.Methods Six patients with iatrogenic foreign body in vascular lamina were treated by 6 interventional operations in our hospital from October 2005 to October 2009.Two peripherally inserted central catheter（PICC） fragments in pulmonary artery,one filter that did not expand in inferior vena cave（IVC）,one snare loop fragment,one fragment of stent transporter and 1 fragment of filter hook were retrieved with 12 French sheath,snare loop,grasping forceps and catheter.Results All 6 foreign bodies were successfully retrieved,success rate was 100%（6/6）.Two PICC were retrieved with pigtail catheter and loop made from guide wire.The unexpanded filter in IVC was retrieved through phlebotomy after drawn into by snare loop.One filter and ruptured snare loop were retrieved with grasping forceps.The fragment of stent transporter in popliteal artery was retrieved with underpressure aspiration through long sheath.One filter was not retrieved due to hook fragmentation.No operation-related complications occurred in and after interventional operation.Conclusion Percutaneous endovascular retrieval for iatrogenic foreign bodies has advantages of high successful rate of retrieval,good clinical efficacy and low complications rate.It should be a good choice of management for iatrogenic foreign bodies.

关 键 词：异物 导管插入术 医源性 

分 类 号：R543[医药卫生—心血管疾病]