锁骨下动脉穿刺插管的临床应用

Clinical Application of Subclavian Artery Catheterization

目的：探讨锁骨下动脉（ＳＣＡ）穿刺插管的安全性和临床应用价值。材料与方法：２５６例胸、腹及盆腔疾病需行介入治疗的患者，行左锁骨下动脉穿刺和选择性及超选择性插管。结果：ＳＣＡ穿刺插管技术成功率为１００％，经ＳＣＡ超选择插管成功率为９８％（１８７／１９０）。为胸、腹、盆腔恶性肿瘤建立动脉内导管药盒系统２１７例。超选择性插管为行胃十二指肠动脉、肠系膜上动脉或肝动脉分支栓塞３７例。行髂总动脉造影１例，行髂外动脉溶栓及球囊扩张和支架植入术１例。并发症包括气胸８例，其中大量气胸３例；１例血胸患者行闭式引流治疗后愈合；局部大血肿３例，其中１例休克，经抗休克及手术缝扎ＳＣＡ后痊愈。结论：经皮左锁骨下动脉穿刺插管是一种安全、有效的方法，可广泛用于胸部、腹部、盆腔及双下肢的动脉造影及介入治疗，是经股动脉入路的必要补充。

Objective: To evaluate the safety and efficacy of percutaneous transsubclavian arterial catheterization (PSAC).Materials and Methods:PSAC were performed in 256 patients with thoracic, abdominal and pelvic disease requiring interventional managment.Results:PSAC was successfully performed in 256 cases (100%). Superselective cannulation of abdominal artery was achieved in 98% (187/190) cases. Portcatheter systems were implanted in 217 patients with thoracic, abdominal and pelvic malignant tumors. Embolization of the branchs of gastrodudanal, hepatic, superior mesentric arteries were complished in 37 cases after superselective cannulation. Common iliac arteriography in one case, thrombolytic theraphy, ballon angioplasty and stent implantation of external iliac artery were successfully achieved in one case. The complications related to the technique included pneumothorax ([WT8.5BX〗n=[WT8.5BZ〗8), hemothroax ([WT8.5BX〗n=[WT8.5BZ〗1) and large haemotoma ([WT8.5BX〗n=[WT8.5BZ〗3). Shock with large local haemotoma was responded after ligation of subclavian artery in one case. Massive pneumothrax ([WT8.5BX〗n=[WT8.5BZ〗3) and hemothrax ([WT8.5BX〗n=[WT8.5BZ〗1) were managed by close drainage.Conclusion: It is believed that PSAC provide a safe and effective way for arteriography and interventional treatment of thorax, abdomen, pelvis and lower limbs, especially for portcatheter system implantation and should be a complementary approach for transfemoral.