颈静脉、锁骨下静脉汇入无名静脉区的影像解剖分型研究及其在中心静脉置管中的应用  

Study on imaging anatomy classification of jugular vein and subclavian vein into innominate vein area and its application in central venous catheterization

作　　者：徐志宾[1] 徐远[2] 王鑫[2] XU Zhi-bin;XU Yuan;WANG Xin(Department of Imaging,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,Henan,CHINA;Central Venous Catheterization Clinic,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,Henan,CHINA)

机构地区：[1]河南科技大学第一附属医院影像科,河南洛阳471003 [2]河南科技大学第一附属医院中心静脉置管门诊,河南洛阳471003

出　　处：《海南医学》2024年第2期258-261,共4页Hainan Medical Journal

摘　　要：目的 研究双侧颈静脉、锁骨下静脉汇入无名静脉“三岔口”区的局部影像解剖并进行分型,初步探讨其在中心静脉置管中的应用。方法 河南科技大学第一附属医院2020年10月至2022年11月中心静脉置管病例389例,根据锁骨下静脉、颈静脉汇入无名静脉区局部影像解剖特点进行分型,右侧分为5型,左侧分为4型,结合置管后胸部X线片、CT检查、腔内心电及超声等资料明确中心静脉管位置,采用统计学方法分析“三岔口”区影像解剖分型与中心静脉导管异位的关系。结果 389例病例右侧“三岔口”区影像解剖分型中Ⅰ型占44.7%、Ⅱ型占24.7%、Ⅲ型占10.3%、Ⅳ型占17.2%、Ⅴ型占3.1%;左侧“三岔口”区影像解剖分型中Ⅰ型占29.3%、Ⅱ型占59.9%、Ⅲ型占9.8%、Ⅳ型占1.0%。经外周置入中心静脉导管(PICC)共271例,右侧入路180例中导管异位共24例,其中Ⅰ型3例、Ⅱ型5例、Ⅲ型4例、Ⅳ型7例、Ⅴ型5例,左侧入路91例中导管异位共3例,其中Ⅱ型2例、Ⅲ型1例;中心静脉导管异位发生率PICC右侧入路各型比较差异有统计学意义(χ^(2)=11.796,P=0.019),左侧入路各型比较差异无统计学意义(χ^(2)=2.073,P=0.557)。CVC置管118例,右侧入路104例中导管异位5例,其中Ⅱ型2例、Ⅲ型2例、Ⅳ型1例,左侧入路14例中导管异位3例,其中Ⅱ型2例、Ⅳ型1例,中心静脉导管异位发生率CVC右侧入路各型比较差异无统计学意义(χ^(2)=7.403,P=0.116),左侧入路各型比较差异无统计学意义(χ^(2)=4.497,P=0.213)。结论 颈静脉、锁骨下静脉汇入无名静脉区的影像解剖分型右侧Ⅰ型最多见,左侧Ⅱ型最多见,局部影像解剖分型与中心静脉导管异位存在一定关系。Objective To study the local imaging anatomy and classification of bilateral jugular vein and sub-clavian vein into the innominate vein area,and to explore its application in central venous catheterization.Methods A total of 389 cases of central venous catheterization in the First Affiliated Hospital of Henan University of Science and Technology from October 2020 to November 2022 were classified according to the local imaging anatomical characteris-tics of subclavian vein and jugular vein into innominate vein area.The right side was divided into 5 types,and the left side was divided into 4 types.The location of central venous catheter was determined by combining chest X-ray,CT examina-tion,intracavitary electrocardiogram and ultrasound after catheterization.The relationship between imaging anatomical classification and ectopic central venous catheter was analyzed by statistical method.Results The imaging anatomical classification of the right side showed typeⅠ44.7%,typeⅡ24.7%,type Ⅲ10.3%,type Ⅳ17.2%,and typeⅤ3.1%.The imaging anatomical classification of the left side showed typeⅠ29.3%,typeⅡ59.9%,typeⅢ9.8%,and type Ⅳ1.0%.There were 271 cases of peripherally inserted central catheter(PICC)catheterization,180 cases of right approach(24 cases of ectopic central venous catheter,including 3 cases of typeⅠ,5 cases of typeⅡ,4 cases of typeⅢ,7 cases of typeⅣ,5 cases of typeⅤ),91 cases of left approach(3 cases of ectopic central venous catheter,including 2 cases of typeⅡand 1 case of typeⅢ).There was a statistically significant difference in the incidence of ectopic central venous catheter among the types of PICC right approach(χ^(2)=11.796,P=0.019),and there was no significant difference among the types of left approach(χ^(2)=2.073,P=0.557).There were 118 cases of central venous catheter(CVC)catheterization,104 cases of right approach(5 cases of ectopic central venous catheter,including 2 cases of typeⅡ,2 cases of typeⅢ,and 1 case of typeⅣ),14 cases of left approach(3 cases of ectop

关 键 词：颈静脉 锁骨下静脉 无名静脉 影像解剖 经外周置入中心静脉导管 颈内静脉穿刺置入中心静脉导管 

分 类 号：R324[医药卫生—人体解剖和组织胚胎学]