超声联合C臂X线机定位下静脉输液港植入技术的应用  

Ultrasound combined with C-arm X-ray machine technology guided implantable venous access port placement

作　　者：李荣钢[1] 陈江湖[1] 高飞[1] 郑晓春[1] LI Rong-gang;CHEN Jiang-hu;GAO Fei;ZHENG Xiao-chun(Department of Anesthesia,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院麻醉科,福州350001

出　　处：《创伤与急诊电子杂志》2018年第1期30-33,共4页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨应用超声联合C臂X线机定位植入输液港用于患者化疗。方法 2011年12月至2015年3月之间需要化疗患者64例,应用超声联合C臂X线机定位植入输液港。记录植入入路、过程、并发症的发生和处理办法。结果 64例患者中经右颈内静脉入路31例﹑右锁骨下入路4例﹑左颈内静脉入路28例﹑左锁骨下入路1例。导管留置时间(222.83±56.59)天,终身带管1例。所有患者深静脉穿刺均一次成功,无血肿﹑误穿动脉﹑血气胸等深静脉穿刺并发症。3例患者出现皮瓣坏死,2例经由重做皮瓣缝合后,保留输液港。1例皮瓣坏死,输液港外露,取出输液港。2例患者的输液港后期回抽回血不顺畅,用尿激酶注射入输液港处理,回血顺畅继续化疗。1例患者经右锁骨下入路留置导管7个月后,发现导管尖端进入右颈内静脉,多次应用脉冲式抽吸推注肝素液并让患者反复跳跃,经胸片证实导管尖端重新进入上腔静脉。结论超声定位下可以提高首次穿刺成功率,减少深静脉穿刺的并发症。联合C臂X线机定位下精确锚定导管尖端位置,全程实现可视化,是实现输液港植入术安全有效的方法。Objective To explore the application of ultrasound combined with C-arm X-ray machine technology for the placement of implantable venous access port in patients receiving chemotherapy. Methods Sixty-four cases of chemotherapy patients between December 2011 and March 2015 were reviewed. They underwent venous access port implantation guided by ultrasound combined with C-arm X-ray machine. The approach, process, as well as the occurrence and treatment of complications were recorded. Results Among 64 patients, 31 cases received right internal jugular vein approach, 4 cases right subclavian approach, 28 cases left internal jugular vein approach, 1 case left subclavian approach. The average catheter retention time was （222.83±56.59） days with 1 case of life-long tube. All the operations were successful at the first time. There was no complications such as hematoma, misleading the catheter into artery and hemopneumothorax. Three patients appeared flap necrosis, and 2 of them kept the ports after flap resuture and 1 port was removed because of the exposure. Two patients’ blood drawing went back to smooth after injecting urokinase into the access ports. One case of the insertion of catheter into the right internal jugular vein was found 7 months after operation. The catheter re-entered the superior vena cava and was confirmed by the chest after pulse pumping injection of heparin fluid and repeated jump workout of the patient. Conclusion Ultrasound guiding can improve the success rate of the first puncture and reduce the complications.Ultrasound combined with C-arm X-ray machine technology can be used to accurately anchor the catheter tip position and make the whole process visible. Thus, it is a safe and effective method for access port implantation

关 键 词：超声 完全植入式输液港 放射学 

分 类 号：R730.53[医药卫生—肿瘤]