15例医源性血管内异物的取出经验

Treatment of iatrogenic intravascular foreign body: Experience of 15 cases

目的探讨不同情况下医源性血管内异物的取出方法和技巧。方法对15例医源性血管内异物患者(包括中心静脉导管2例、锁骨下深静脉穿刺导管2例、深静脉输液港导管6例、可回收滤器3例和穿刺血管鞘断端、V18导丝头端各1例),根据异物种类、残留血管腔位置及血管腔大小,分别采用介入和外科手术或介入联合外科手术方法进行处理。结果采用外科手术取出1例锁骨下深静脉穿刺导管及1例V18导丝;对1例可回收滤器,先用介入方法将下腔静脉滤器移至髂股静脉,再用外科手术方法取出;用EV3鹅颈式抓捕器、三叶草式抓捕器或自制抓捕器介入取出其余12例血管内异物。所用时间20min～4h,患者无明显不良反应。结论采用介入方法可取出医源性血管内异物,必要时可行局部手术切开或介入联合外科手术局部切开取出。

Objective To discuss endovascular skills and tips for treatment of iatrogenic intravascular foreign body under different circumstances. Methods Totally 15 patients with iatrogenic intravascular foreign body were analyzed, including 2 cases of central venous catheter, 2 cases of peripherally inserted central catheter, 6 of central venous port access system, 3 of recyclable vena cava filter, 1 of broken vascular sheath and 1 case of residual tip of V-18 wire. Endovascular interven- tion, open surgery as well as combined therapy of endovascular intervention and open surgery were adopted according to different types of foreign bodies, the location and the diameter of the involved vessel lumen. Results The foreign bodies in 12 cases were removed with snares, of 1 case with subclavian vein catheter. The residual V-18 wire was treated with open surgery in 1 case, while the vena cava filter in 1 case was moved to iliac-femoral vein and then treated with phlebotomy. The treatment took 20 minutes to 4 hours without significant complications. Conclusion Iatrogenic intravascular foreign body can be treated interventionally, while in some circumstances, open surgery or combined therapy of endovascular inter- vention and open surgery should be considered.