血管腔内技术治疗医源性血管内异物的安全性及有效性分析  

Safety and effectiveness of endovascular technique in the treatment of iatrogenic intravascular foreign bodies

作　　者：陈银珍 林鸿铭 许磊 周日东 郑纪昌 林晨[1,2,3,4] 陈小彬 Chen Yinzhen;Lin Hongming;Xu Lei;Zhou Ridong;Zheng Jichang;Lin Chen;Chen Xiaobin(Department of General Surgery,Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine(900th Hospital),Fuzhou 350000,Fujian,China;Department of General Surgery,Fuzong Clinical Medical College of Fujian Medical University,Fuzhou 350000,Fujian,China;Department of General Surgery,Dongfang Hospital of Xiamen University,School of Medicine,Xiamen University,Fuzhou 350000,Fujian,China;Department of General Surgery,900th Hospital of PLA Joint Logistic Support Force,Fuzhou 350000,Fujian,China)

机构地区：[1]福建中医药大学福总教学医院(第九〇〇医院)普通外科,福建福州350000 [2]福建医科大学福总临床医学院普通外科,福建福州350000 [3]厦门大学附属东方医院普通外科,福建福州350000 [4]中国人民解放军联勤保障部队第九〇〇医院普通外科,福建福州350000

出　　处：《血管与腔内血管外科杂志》2025年第2期155-160,175,共7页Journal of Vascular and Endovascular Surgery

基　　金：福建省自然科学基金面上项目(2023J01206);第九〇〇医院训练伤防治专项研究项目(2023XL02);2024年度福建中医药大学校管课题临床专项(XB2024245)。

摘　　要：目的探讨采用血管腔内技术治疗医源性血管内异物(IFB)的安全性及有效性。方法收集2013年1月至2023年12月福建中医药大学福总教学医院(第九〇〇医院)收治的13例发生医源性IFB的患者的临床资料,对其异物类型、异物滞留部位、治疗方式等进行总结,结合相关文献,综合分析血管腔内技术治疗医源性IFB的疗效。结果13例患者的异物类型:7例输液港断离,3例中心静脉导管断离,1例导丝脱落以及2例下腔静脉滤器断离。异物滞留血管位置:5例患者异物整体位于右心房内;3例整体位于下腔静脉内;2例整体位于上腔静脉内;1例一端位于上腔静脉,另一端位于右心房内;1例一端位于肝静脉,另一端位于右心房内;1例位于整个腔静脉内。13例患者的血管腔内异物均采用介入手段顺利取出,且均通过右股静脉通路进行,技术成功率高达100%。11例患者采用单纯的单弯导管配合鹅颈抓捕器成功将IFB取出,2例中心静脉导管断裂的患者采取其他介入手段(猪尾导管配合鹅颈抓捕器)将异物取出,术后均接受针对性抗凝治疗。所有患者术后均行X线或计算机断层扫描(CT)检查,提示IFB均取出,无异物残留。所有患者术后均未出现并发症,随访复查血管通畅。结论介入治疗是IFB的首选治疗方式,大部分IFB均可通过鹅颈抓捕器进行抓捕,而当异物与血管壁粘连严重导致单纯抓捕器抓取难度较大时,可以通过导丝或导管辅助抓捕器间接抓捕IFB,具有较好的有效性及安全性。Objective To investigate the safety and efficacy of endovascular technique in the treatment of iatrogenic intravascular foreign body(IFB).Method Clinical data of 13 patients with iatrogenic IFB treated in Fuzong Teaching Hospital of Fujian University of Traditional Chinese Medicine(900th Hospital)from January 2013 to December 2023 were collected,and the types,retention sites and treatment methods of iatrogenic IFB were summarized.Combined with the related literature reports,the curative effect of endovascular treatment of iatrogenic IFB was comprehensively analyzed.Result The types of foreign bodies in 13 patients include:infusion port in 7 cases,central venous catheter in 3 cases,guide wire detachment in 1 case and inferior vena cava filter in 2 cases.The location of foreign bodies in blood vessels included:5 cases of foreign bodies were located in the right atrium;3 cases of foreign bodies were located in inferior vena cava;2 cases of foreign bodies were located in the superior vena cava;one case of foreign body was located in superior vena cava and the other in right atrium;one foreign body was located in the hepatic vein and the other in the right atrium;one case of foreign body was located in the whole vena cava.A total of 13 cases of IFB were successfully removed by interventional methods,and all of them were carried out through the right femoral vein,and the technical success rate was as high as 100%.Eleven patients successfully took out the foreign body in the blood vessel by using a single curved catheter combined with a gooseneck catcher,and two patient with a broken central venous catheter took out the foreign body by other interventional methods(pigtail catheter combined with a gooseneck snare).All patients were treated with targeted anticoagulation after operation.All patients were examined by X-ray or computed tomography(CT)after operation,which indicated that all intravascular abnormalities were removed and no foreign body remained.All patients had complications after operation,and the blood vessel

关 键 词：血管腔内技术 医源性 血管内异物 鹅颈圈套 疗效 

分 类 号：R543[医药卫生—心血管疾病]