不同途径植入静脉输液港的临床应用比较

发布时间：2018-06-24 17:26

本文选题：锁骨下静脉 + 颈内静脉　；参考：《重庆医学》2016年11期

【摘要】：目的分析比较在DSA引导下经颈内静脉、经锁骨下区锁骨下静脉、经锁骨上区锁骨下静脉植入静脉输液港(CVP)患者的手术成功率、并发症发生率及手术舒适度的异同,探讨不同手术方式的利弊。方法回顾性分析2012年12月至2013年12月188例因肿瘤在DSA引导下植入CVP治疗的患者资料。根据患者植入途径分为经颈内静脉组(A组)、经锁骨下区锁骨下静脉组(B组)、经锁骨上区锁骨下静脉组(C组),跟踪随访比较各组术中疼痛评分、围术期及术后近期、远期并发症发生率。结果所有患者均成功植入CVP,术中、术后无致死性并发症发生。每组中均有1例患者出现导管感染所致发热,组间差异无统计学意义(P0.05)。B组中2例(2.1%,2/96)、C组中1例(1.7%,1/60)患者出现锁骨下静脉血栓,其中C组患者左锁骨下静脉完全闭塞,经接触溶栓治疗后未能再通,B组患者经接触溶栓治疗后血管再通良好。A组及C组患者的导管错位、导管折曲发生例数较B组患者多,且差异有统计学意义(P0.01)。A、C组患者的远期并发症发生率均较B组高(P0.05)。导管夹闭仅在B组出现2例;各组在导管破裂、静脉港翻转、伤口裂开比较差异无统计学意义(P0.05)。结论在DSA引导下经锁骨下静脉入路植入CVP安全有效,且患者术中更舒适,并发症发生率更低,可在植入CVP时优先考虑。
[Abstract]:Objective to compare the surgical success rate, incidence of complications and surgical comfort in patients with subclavian vein implantation via internal jugular vein, subclavian vein and supraclavian subclavian vein under DSA guidance. To discuss the advantages and disadvantages of different surgical methods. Methods from December 2012 to December 2013, 188 patients with tumor were treated with CVP implantation under DSA guidance. Patients were divided into subclavian vein group (group A), subclavian vein group (group B) and supraclavicular subclavian vein group (group C). Incidence of long term complications. Results CVP was implanted successfully in all patients. No fatal complications occurred during operation. One patient in each group had fever caused by catheterization. There was no significant difference between groups (P0.05). 2 out of 2 patients in group B (2.1 / 96) had subclavian venous thrombosis in group C (1.7g / 60), and the left subclavian vein was completely occluded in group C. After contact thrombolytic therapy, the patients in group B failed to recanalize the vascular recanalization after contact thrombolytic therapy. The patients in group A and group C had misplaced ducts, and the number of cases of ductal buckling was more than that of group B. And the difference was statistically significant (P0.01). The incidence of long-term complications in group A was higher than that in group B (P0.05). There were only 2 cases in group B with ductal clipping. There was no significant difference in catheter rupture, venous port turnover and wound opening in each group (P0.05). Conclusion CVP implantation via subclavian vein under DSA guidance is safe and effective, and the patients are more comfortable during operation and have lower incidence of complications.
【作者单位】：贵阳医学院附属医院介入科;贵州省肿瘤医院介入科;
【基金】：贵州省科技计划课题(黔科合SY字[2012]3145号)
【分类号】：R472

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