胸大肌下埋藏式心脏复律除颤器囊袋制作方法及其应用价值

Techniques and Applied Value of Pocket Beneath the Major Pectoral Muscle in Implantation of Cardiovertor Defibrillator

目的探讨胸大肌下埋藏式心脏复律除颤器(ICD)囊袋制作的方法及其应用价值。方法对50例ICD植入患者采用胸大肌下(23例)和皮下(27例)两种囊袋制作方法,比较两组囊袋制作所需时间和随访3～84月(25.2±15.3)局部血肿、疼痛、晚期破溃和/或感染的发生率。结果囊袋制作时间胸大肌下组16.4±5.2min,皮下组5.3±2.3min,差异有显著性意义(P<0.05);晚期局部皮肤破溃+感染胸大肌下组无1例发生,皮下组破溃3例、感染2例,差异有显著性意义(P<0.05),两组局部血肿、疼痛差异均无显著性意义(P>0.05)。结论胸大肌下ICD囊袋植入虽操作时间相对较长,但晚期感染+皮肤破溃发生率明显低于皮下植入,前者正确的制作加彻底止血可以减少局部出血等并发症的发生。

Objective To discuss the techniques and the applied value of pocket beneath the major pectoral muscle in implantation of cardiovertor defibrillator. Methods Of 50 consecutive patients receiving implantable cardiovertordefibrillators, 23 selected pockets beneath the major pectoral muscle （submuscular group） and 27 subcutaneous pockets （subcutaneous group）. Procedural time, pocket hematoma, pain, late skin erosion and wound infection during follow-up of 3-84 （25.2 ± 15.3） monthswere compared between two groups. Results The procedural time was significantly longer in submuscular group （16.4 ± 5.2 min ） than in subcutaneous group（5.3 ± 2.3 min）（P〈0.05 ）. There were 3 late skin erosion and 2 wound infection in subcutaneous group and no one in submuscular group （P〈0.05）. The pocket hematoma and pain occurred similarly in two groups （P〉0.05）. Conclusion The pocket beneath the major pectoral muscle in implantation of cardiovertor defibrillator can be performed safely with lower rate of late skin erosion and wound infection except longer procedural time. Correct procedure and hemostasia are keys to reduce pocket hematoma.