摘要
目的探讨经左侧腋静脉近侧段完全植入式静脉输液港(TIVAP)穿刺方式的可行性、安全性及影响因素。方法回顾性分析2015年8月至2020年4月在上海市公共卫生临床中心经左侧腋静脉近侧段植入TIVAP的252例患者临床资料。根据不同穿刺方式,将患者分为超声实时导引穿刺组(n=38)、超声定位标记盲穿刺组(n=84)、骨性标志盲穿刺组(n=49)、X线透视定位盲穿刺组(n=41)、静脉造影导引穿刺组(n=40)等5组。分析各组穿刺成功率、穿刺相关并发症发生率及影响穿刺成功率的因素。结果超声实时导引穿刺组、超声定位标记盲穿刺组、骨性标志盲穿刺组、X线透视定位盲穿刺组、静脉造影导引穿刺组首次1针穿刺成功率,分别为94.7%、82.1%、65.3%、70.7%、75.0%,2~3针成功率分别为100%、96.4%、83.7%、87.8%、92.5%。252例中11例(4.37%)误穿刺动脉,3例(1.19%)发生气胸,无伤口渗血、血胸、腋神经损伤等严重穿刺相关并发症。超声定位标记盲穿刺患者体质量指数(BMI)越小、腋静脉横径越宽、腋静脉距体表距离越短,穿刺成功率越高。腋静脉横径为8.45 mm时曲线下面积为0.782,则Youden指数最大,灵敏度为76.8%,特异度为66.7%,提示腋静脉横径<8.45 mm时不推荐盲穿刺。结论超声实时导引下穿刺腋静脉近侧段成功率高、穿刺相关并发症少。超声定位标记盲穿刺法、静脉造影导引穿刺法是可行的替代方式。临床实践中需根据患者实际情况、术者经验习惯、科室器械配置等灵活选择穿刺导引方式。
Objective To explore the feasibility and safety of the implantation of totally implantable venous access port(TIVAP)via left proximal axillary venous approach,and to discuss the factors affecting the success rate.Methods The clinical data of 252 patients,who received implantation of TIVAP via left proximal axillary venous approach at the Affiliated Shanghai Public Health Clinical Center of Fudan University of China between August 2015 and April 2020,were retrospectively analyzed.According to the puncturing methods,the patients were divided into real-time ultrasound-guided group(group A,n=38),blind puncture based on ultrasound positioning marker group(group B,n=84),blind puncture based on bone marker group(group C,n=49),b lind puncture based on fluoroscopic positioning group(group D,n=41),and venography-guided puncture group(group D,n=40).The success rate of puncture,related complications and influencing factors of puncture were analyzed.Results The success rates of initial puncture with single-puncturing in the group A,B,C,D and E were 94.7%,82.1%,65.3%,70.7%and 75.0%respectively,and the puncture success rates with 2-3 times of puncturing were 100%,96.4%,83.7%,87.8%and 92.5%respectively.Of the 252 patients,mis-puncture of artery was seen in 11(4.37%)and pneumothorax occurred in 3(1.19%).No serious puncture-related complications such as oozing of blood at wound area,hemothorax,or axillary nerve injury occurred.In group B,the smaller the body mass index(BMI),the greater the transverse diameter of the axillary vein and the shorter the distance between axillary vein and the body surface were,the higher the puncture success rate would be.When the transverse diameter of the axillary vein was 8.45 mm,the area under the curve was 78.2%,and,under this circumstance,the Jorden index was the largest,the sensitivity was 76.8%and the specificity was 66.7%,which suggested that when the transverse diameter of the axillary vein was less than 8.45 mm,blind puncture method shouldn’t be recommended.Conclusion Real-time ultrasound-
作者
陈天佑
袁敏
杨柏帅
周粟
侯毅斌
CHEN Tianyou;YUAN Min;YANG Boshuai;ZHOU Su;HOU Yibin(Department of Interventional Radiology,Affiliated Shanghai Public Health Clinical Center of Fudan University,Shanghai 201508,China)
出处
《介入放射学杂志》
CSCD
北大核心
2021年第12期1286-1291,共6页
Journal of Interventional Radiology
基金
上海市公共卫生临床中心院级科研课题项目(KY-GW-2019-09)。
关键词
完全植入式静脉输液港
腋静脉
穿刺术
totally implantable venous access port
axillary vein
puncture
