多层螺旋CT上腔静脉三维成像技术在评估Cuff导管植入术后导管功能障碍中的应用价值  

Application of three-dimensional imaging of superior vena cava with multi-slice spiral CT in the evaluation of catheter dysfunction after Cuff catheter implantation

作　　者：刘莉娜 关建中 谢立旗 林斐斐 Liu Lina;Guan Jianzhong;Xie Liqi;Lin Feifei(Department of CT Examination,No.971 Hospital of PLA Navy,Qingdao 266071,Shandong,China)

机构地区：[1]海军第九七一医院CT室,山东青岛266071

出　　处：《海军医学杂志》2024年第10期1091-1094,共4页Journal of Navy Medicine

摘　　要：目的探讨多层螺旋CT上腔静脉三维成像技术在Cuff导管植入术后评估导管功能障碍中的应用价值。方法回顾性分析2019年5月至2021年8月海军第九七一医院因慢性肾衰竭行双腔带Cuff导管留置术,且术后出现导管功能障碍并接受CT上腔静脉三维成像(上腔静脉CTV)的20例患者的临床资料。上述患者中进行颈部血管彩超者13例、数字减影血管造影(DSA)检查者7例。将上腔静脉CTV结果、彩超结果、DSA检查结果进行比较分析。结果20例接受CT上腔静脉三维成像检查者中,CT图像清晰显示导管植入不同血管的位置,明确显示了导管尖端所在位置。呈现Cuff导管的情况分别为:周围血栓致功能障碍15例,导管滑脱2例,植管后皮下隧道疼痛2例,无明显症状1例。行颈部彩超检查的13例中,仅有1例显示头臂静脉上段血栓形成,5例显示颈部静脉管腔扩张或内径略小或仅有细小血流通过,余7例未显示。行DSA检查7例,均用于分析长期血液透析导管血流量减低及造瘘后肿胀手的原因、DSA引导下重新植管及长期血液透析导管纤维鞘去除术等诊疗应用。结论改良的上腔静脉CT三维成像技术空间分辨率高、可重复性强,能立体直观地显示血液透析患者Cuff导管植入血管位置、尖端所在位置、血管通路是否有血栓形成等情况。颈部血管彩超仅作为粗略评价之用;DSA为有创检查,更倾向用于临床治疗。上腔静脉CTV在敏感性、特异性及检查范围上都有较大优势,是评估Cuff导管植入术后导管功能障碍原因中优先选择的检查方法。Objective To explore the application of three-dimensional imaging of the superior vena cava(SVC)with multi-slice spiral CT in the evaluation of catheter dysfunction after Cuff catheter implantation.Methods Twenty patients who underwent double lumen Cuff catheter indwelling for chronic renal failure at the No.971 Hospital of PLA Navy from May 2019 to August 2021,had postoperative catheter dysfunction and underwent CT three-dimensional imaging of SVC were analyzed retrospectively.Thirteen patients underwent carotid duplex ultrasound and 7 patients underwent digital subtraction angiography(DSA).The results of CT three-dimensional imaging of SVC,carotid duplex ultrasound and DSA were compared and analyzed.Results CT images clearly showed the position of the catheter implanted into different blood vessels and the location of the catheter tip in the 20 patients.There were 15 cases of dysfunction caused by peripheral thrombus,2 cases of catheter lippage,2 cases of subcutaneous tunnel pain and 1 case of no obvious symptoms after Cuff catheter implantation.Among the 13 patients undergoing carotid duplex ultrasound,thrombosis was found in the upper segment of brachiocephalic veins in one patient,dilatation or slightly smaller diameter of cervical vein or only small blood flow in 5 patients,and no abnormality in the remaining 7 patients.In the 7 patients with DSA examination,DSA was used to analyze the causes of the decrease of blood flow of long-term hemodialysis catheter and the hand swelling after fistulization,the catheter reimplantation under the guidance of DSA and the removal of fiber sheath of long-term hemodialysis catheter.Conclusion The improved CT three-dimensional imaging technique of SVC has high spatial resolution and strong repeatability,and can stereoscopically and intuitively display the position of Cuff catheter implanted into blood vessels,the location of catheter tip and thrombosis in hemodialysis patients.Carotid duplex ultrasound is only used for rough evaluation.DSA is an invasive examination and is

关 键 词：上腔静脉三维成像 Cuff导管植入术 多层螺旋CT 应用价值 

分 类 号：R814.42[医药卫生—影像医学与核医学]