超声联合DSA引导下单切口经腋静脉输液港植入术的临床应用

刘伟夫; 张孔志; 余文昌; 陈示光; 王小珑

doi:10.3971/j.issn.1000-8578.2021.21.0571

超声联合DSA引导下单切口经腋静脉输液港植入术的临床应用

Application of Ultrasound Combined with DSA-guided Single-incision Technique via Axillary Vein Access in Implantation of Totally Implantable Venous Access Port

摘要

摘要:
目的探讨超声联合数字减影血管造影技术（DSA）引导下行单切口经腋静脉（AV）入路植入输液港（TIVAP）在临床应用中的可行性及安全性。
方法回顾性分析在福建省肿瘤医院就诊并接受超声联合DSA引导下行单切口经AV入路TIVAP植入术的240例患者临床资料。记录手术相关信息，包括AV宽度、AV穿刺成功率、植入成功率、超声引导穿刺时间、手术时间及术中、术后并发症等。
结果 240例患者均成功植入TIVAP，植入成功率100%。229例患者于超声联合DSA引导下行单切口经AV穿刺植入TIVAP，AV穿刺成功率95.42%（229/240），11例因AV穿刺失败，改超声联合DSA引导下经同侧颈内静脉（IJV）穿刺植入TIVAP。240例患者术前超声探查定位下测得拟穿刺段AV平均宽度为（7.56±1.26）mm，其中AV 1次穿刺成功195例，2次穿刺成功26例，3次穿刺成功8例，成功率分别为81.25%、10.83%、3.34%；超声引导下平均穿刺时间（0.85±0.52）min，手术平均时间（25.9±4.8）min。术中并发症发生率为1.67%（4/240），未发生血胸、血气胸及严重致死性并发症；TIVAP留置期间相关并发症发生率为2.92%（7/240），未见导管相关血流感染、导管相关静脉血栓、导管断裂/移位、夹闭综合征、药物外渗等并发症发生。
结论超声联合DSA引导下行单切口经AV植入TIVAP术是一种可行且安全的植入方式，具有较高的成功率、较短的手术时长和较低的并发症风险，可作为TIVAP植入方式的另一种选择。

Abstract:
Objective To evaluate the technical feasibility and safety of a single-incision technique via axillary vein (AV) for placement of totally implantable venous access port (TIVAP) guided by ultrasound combined with DSA in clinical application.
Methods We retrospectively analyzed clinical data of 240 patients who received TIVAP by single incision technique via AV access guided by ultrasound combined with DSA. We observed and recorded operation-related information such as AV width, AV puncture success rate, implantation success rate, ultrasound-guided puncture time, operation time and intraoperative and postoperative complications, etc.
Results All 240 patients were successfully implanted with TIVAP, and the success rate was 100%. In 229 cases, TIVAP was implanted through single-incision AV puncture under the guidance of ultrasound combined with DSA, and the success rate of AV puncture was 95.42% (229/240). In 11 cases, TIVAP was implanted through the ipsilateral internal jugular vein (IJV) under the guidance of ultrasound combined with DSA due to the failure of AV puncture. In the 240 patients, the average width of AV of the intended puncture segment was (7.56±1.26) mm measured by preoperative ultrasound exploration and positioning, in which 195 cases were successfully punctured once, 26 cases were successfully punctured twice, and 8 cases were successfully punctured three times, with the success rate of 81.25%, 10.83% and 3.34%, respectively. The average puncture time under ultrasound guidance was (0.85±0.52) min, and the average operation time was (25.9±4.8) min. The incidence of intraoperative complications was 1.67% (4/240). No hemothorax, hemopneumothorax or serious fatal complications occurred. The incidence of complications during TIVAP retention was 2.92% (7/240). No complication such as catheter-related bloodstream infection, catheter-related venous thrombosis, catheter rupture/displacement, clipping syndrome or drug extravasation was observed.
Conclusion Ultrasound combined with DSA guided single-incision technique via AV access in the implantation of TIVAP is a feasible and safe implantation method with high technical success rate, short operation time and low risk of complications. It can be used as another choice of TIVAP implantation method.

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