植入式静脉港体内导管纤维蛋白鞘形成的诊断及处理  

The diagnosis and treatment of fibrin shell formation of central verlous port access system

作　　者：王建新[1] 武中林[2] 苏金娜[1] 王伟娜[1] 谢艳丽[1] 王建平[1] 

机构地区：[1]河北医科大学第四医院乳腺中心,河北石家庄050011 [2]河北医科大学第四医院放射科,河北石家庄050011

出　　处：《河北医科大学学报》2016年第9期1047-1050,共4页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题(ZD20140250)

摘　　要：目的探讨植入式静脉输液港(静脉港)体内导管纤维蛋白鞘形成的诊断及处理方法。方法静脉港导管功能障碍患者131例,采用数字减影血管造影(digital subtraction angiography,DSA)技术,经静脉港蝶翼针外接口,手推造影剂行体内导管造影,分析DSA表现;对诊断明确患者给予尿激酶溶鞘治疗,观察处理效果。结果DSA发现静脉港体内导管纤维蛋白鞘形成51例,占静脉港导管功能障碍的38.9%(51/131),其中体内导管末端局部纤维蛋白鞘形成43例,体内导管弥漫性纤维蛋白鞘形成5例,体内导管广泛性纤维蛋白鞘形成3例。特异影像学表现为DSA下可见沿体内导管外壁走形的线样、柱状或不规则状高密度影包裹体内导管,被包裹的导管管径明显增粗,造影剂可向上反流进入腔静脉、静脉港植入侧或输液座周围皮下软组织内。51例患者给予尿激酶溶鞘治疗后,48例静脉港继续使用,3例静脉港提前摘除。体内导管局部、弥漫性及广泛性纤维蛋白鞘形成尿激酶溶鞘治疗成功率分别为100.0%(43/43)、100.0%(5/5)和0.0%(0/3)。结论 DSA可有效评估静脉港体内导管纤维蛋白鞘形成,纤维蛋白鞘形成是造成静脉港导管功能障碍的主要原因之一,尿激酶对静脉港体内导管末端局部纤维蛋白鞘形成具有良好的治疗效果。Objective To analyze the diagnosis and treatment of fibrin shell formation of central verlous port access system（CVPAS）.Methods There were 131 cases of catheter dysfunction of CVPAS.By using the digital subtraction angiography（DSA）and the external interface of the butterfly wing needle in the portal vein,the contrast agent was performed in vivo,and the DSA expression was analyzed,and the treatment effect was observed.ResultsFifty-one cases of fibrin shell formation were found by DSA,which accounted for 38.9% of the venous port catheter dysfunction（51/131）.Among those,43 cases were localized in the end of the catheter,5cases of diffuse fibrous protein in the body,and 3cases of extensive fibrous sheath formation.DSA specific imaging shows the line,columnar and irregular high density along outer wall of body catheter and parcel body catheter.The diameter of parcel catheter is obvious thickening,The contrast agent reflux into the vena cava,the implantation side of CVPAS and the infusion seat peripheral subcutaneous sofe tissue.Fifty one patients are given urokinase treatment,48 cases CVPAs continue to use,3cases CVPAS anticipate extirpation.The treatment success rates of local,diffuse and extensive fibrin shell formation given urokinase treatment are respectively 100.0%（43/43）,100.0%（5/5）vs 0.0%（0/3）.Conclusion The causes of catheter diffuse fibrin shell formation of CVPAS can be evaluated accurately by means of the DSA.The main cause of catheter dysfunction is fibrin shell formation.Urokinase has good therapeutic effect on local fibrin shell formation.

关 键 词：输注 静脉内 纤维蛋白鞘 血管造影术 数字减影 

分 类 号：R452[医药卫生—治疗学]