【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(P>0.05)。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(P<0.01)。A、C组患者的远期并发症发生率均较B组高(P<0.05)。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(P>0.05)。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。更多还原

【Abstract】 Objective To compare the technical success,complication rates and comfort of the radiologic placement of central venous ports(CVP)via the internal jugular vein,subclavian vein via subclavian region,subclavian vein via supraclavicular region under DSA guidance.Methods We retrospectively reviewed 188 CVP patients implanted at hospitals between December 2012 and December 2013.The patients were divided into three groups according to the different catheter implantation sites,internal jugular vein(group A),subclavian vein via subclavian region(group B)and subclavian vein via supraclavicular region(group C).Intraoperative pain score,technical success rates,peri-procedural,as well as early and late complication rates were recorded based on the image follow-up and patient medical records.Results The technical success rate was 100.0% without any lethal complications.The CVP related infections were occurred in each group with 1patient,but there was no statistics significant different(P>0.05).Subclavian vein thrombosis were occurred 2(2.1%,2/96)in group B,which was recanalized after thrombolytic therapy,and 1(1.7%,1/60)in group C,which was completely occluded.The higher rate of catheter migration and kinking of catheter were occurred in group A and group C.The rate was statistically significant difference among the three groups(P<0.01).The late complication rates were statistically higher in group A and C compared with group B(P<0.05).The punch-off was just occurred in group B(n=2).There were no significant differences about catheter fracture,port rotation and wound dehiscence among the three groups(P>0.05).Conclusion In DSA radiologic placement of a CVP via the subclavian vein via subclavian region is safe and efficient with more comfortable and lower complication rates,which could be chosen priority.更多还原