【摘要】 目的　回顾性分析锁骨下静脉第 2段X线解剖特点 ,探讨X线导引下锁骨下静脉穿刺置管技术的要点。资料与方法　在X线实时监视下 ,采用Arrow中央静脉管 ,行锁骨下静脉穿刺上腔静脉置管 180例次 ,包括右侧 110例次 ,左侧 70例次。穿刺点取锁骨中点下 1～ 2cm ,采用改良Seldinger穿刺技术 ,穿刺针对准锁骨头方向斜向内上、紧贴锁骨后缘穿刺 ,Arrow导管头留置于上腔静脉 ,3M敷贴外固定导管。并记录导管进入锁骨下静脉第 2段的解剖位置。结果　锁骨下静脉第 2段一般走行于锁骨内侧中下 1/3处 ,占 80 .6 % (14 5 /180 )。其解剖位置在左右和性别之间无统计学差异 (P >0 .0 5 )。穿刺成功率 10 0 % ,对准锁骨头中下 1/3处 ,一针穿刺成功率达 95 %。无并发症发生。结论　X线导引下锁骨下静脉穿刺上腔静脉置管术安全、微创 ,成功率高。熟悉锁骨下静脉的X线解剖 ,掌握正确的穿刺方向 ,可以提高一针穿刺成功率。更多还原

【Abstract】 Objective To study X-ray anatomy of the second segment of the subclavian vein and to discuss the technical points of the indwelling catheterization through percutaneous subclavian vein puncturing under X-ray guidance. Materials and Methods With real-time X-ray monitoring, 180 patients underwent SVC indwelling catheterization with a central vein catheter (Arrow, USA) through subclavian vein puncturing (right side 110 and left side 70). The puncture site was at 1～2 cm below the middle point of the clavicle. The needle, directing towards the head of the clavicle and keeping close to the clavicular posterior border, punctured into the subclavian vein. With modified Seldinger technique, the central vein catheter was placed in SVC. 3M application was used to fix the catheter exteriorly. The anatomic relationship between the second segment of the subclavian vein and the clavicle was observed and analyzed.Results In most cases, the second segment of the subclavian vein coursed along the middle and lower 1/3 of the medial half of the clavicle (145/180, 80.6%). No significant difference in its anatomic relationship with the clavicle was found between the right and the left side, and between the female and the male (P>0.05). The technical successful rate was 100%. The successful rate of the procedure with single puncturing was 95%. No complication occurred in all patients.Conclusion SVC indwelling catheterization by means of subclavian vein puncturing under X-ray guidance is a safe, minimally-invasive technique with high successful rate. A familiarity with the X-ray anatomy of subclavian vein and the puncturing skill is the key to improve single-puncturing success rate.更多还原