单切口腋静脉入路技术在完全植入式静脉输液港植入中的应用  

Application of single-incision technique via axillary vein access in the implantation of totally implantable venous access port

作　　者：丁伟 周奇 孙飞虎 孙磊 王维涛 徐平 范晨 王卫东 DING Wei;ZHOU Qi;SUN Feihu;SUN Lei;WANG Weitao;XU Ping;FAN Chen;WANG Weidong(Department of Intervention,Affiliated Wuxi People’s Hospital of Nanjing Medical University,Wuxi,Jiangsu Province 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院介入科,江苏无锡214023

出　　处：《介入放射学杂志》2020年第10期1028-1032,共5页Journal of Interventional Radiology

摘　　要：目的探讨单切口腋静脉(AV)入路技术在完全植入式静脉输液港(TIVAP)植入术中应用的可行性和安全性。方法回顾性分析2018年1月至6月南京医科大学附属无锡人民医院采用单切口AV入路技术植入TIVAP的179例患者临床资料。其中男90例,女89例,平均年龄(46.8±12.5)(23~77)岁。DSA透视解剖定位下穿刺AV。穿刺AV困难(穿刺3次)或误穿刺腋动脉,即改为超声导引下穿刺AV;超声提示目标静脉狭窄或闭塞,即改为同侧颈内静脉(IJV)入路植入TIVAP。观察技术成功率、手术相关信息及TIVAP留置相关并发症情况。结果177例患者通过单切口AV入路成功植入TIVAP,2例术中改行同侧IJV入路完成手术,技术成功率为98.9%(177/179)。平均透视时间(0.8±0.2)(0.3~1.5)min,手术操作时间(21.5±10.3)(17~45)min,TIVAP留置时间(362.5±65.2)(252~442)d。术中操作相关问题发生率为8.9%(16/179),其中误穿刺腋动脉6例,导丝误入同侧IJV 5例,可撕脱鞘折弯3例,导管-港体连接处扭曲2例。TIVAP留置相关并发症发生率为3.4%(6/179),其中局部血肿形成、术侧AV血栓形成、左头臂静脉血栓狭窄-闭塞伴左IJV-锁骨下静脉(SCV)近心端血栓形成、纤维蛋白鞘形成各1例,囊袋局部感染2例,未见导管相关血流感染、导管断裂/移位、夹闭综合征、药物外渗等严重并发症。结论单切口AV入路技术植入TIVAP技术成功率高,安全可行,手术时间短,并发症发生率低,可为TIVAP植入方式提供另一种选择。Objective To investigate the feasibility and safety of single-incision technique via axillary vein(AV)access in the implantation of totally implantable venous access port(TIVAP).Methods The clinical data of 179 patients,who received TIVAP by using single-incision technique via AV access at the Affiliated Wuxi People’s Hospital of Nanjing Medical University of China during the period from January 2018 to June2018,were retrospectively analyzed.The patients included 90 males and 89 females,with a mean age of(46.8±12.5)years(range of 23-77 years).Under DSA guidance,puncturing of AV was performed.If the puncturing of AV was difficult(i.e.puncturing failed three times)or mis-puncturing of the axillary artery occurred,ultrasound-guided puncturing of AV should be employed immediately.When ultrasound demonstrated stenosis or occlusion of the target vein,the implantation of TIVAP should be performed via the ipsilateral internal jugular vein(IJV)access.The technical success rate,surgical information and TIVAP indwelling-related complications were analyzed.Results Successful implantation of TIVAP by using singleincision technique via AV access was accomplished in 177 patients,the technical success rate was 98.9%(177/179).Implantation of TIVAP via ipsilateral IJV access was adopted in the remaining 2 patients.The fluoroscopy time was 0.3-1.5 min,with an average of(0.8±0.2)min.The time spent for operation was17-45 min,with an average of(21.5±10.3)min.The indwelling time of TIVAP was(252-442)days,with an average of(362.5±65.2)days.The incidence of intraoperative procedure-related events was 8.9%(16/179),including mis-puncturing of axillary artery(n=6),guide wire mis-entering ipsilateral IJV(n=5),bending of tearable sheath(n=3),and kinking of the catheter-port body junction(n=2).The incidence of TIVAP indwelling-related complications was 3.4%(6/179),including local hematoma(n=1),operated side AV thrombosis(n=1),left brachiocephalic vein stenosis-occlusion with thrombosis in proximal part of left IJV-SCV(n=1),fibrin sheath

关 键 词：单切口技术 腋静脉 完全植入式静脉输液港 颈内静脉 锁骨下静脉 手术并发症 

分 类 号：R473.5[医药卫生—护理学]