超声引导下不同路径输液港植入术的比较

Comparison of Different Approaches of Ultrasound-Guided Implantation of Venous Access Ports

目的探讨超声引导下不同路径输液港植入术的应用效果。方法选取接受超声引导下经颈内静脉及经锁骨下静脉行输液港植入术患者共328例,分析不同路径的一次穿刺成功率、并发症发生率和非计划输液港拆除率。结果颈内静脉组及锁骨下静脉组的一次穿刺成功率分别为95.05%(192/202)和93.65%(118/126),比较差异无统计学意义(χ2=0.293,P=0.588);颈内静脉组的并发症总发生率、围手术期并发症发生率、远期并发症发生率、非计划输液港拆除率分别为11.39%(23/202)、3.96%(8/202)、7.43%(15/202)、4.95%(10/202),而锁骨下静脉组的分别为17.39%(22/126)、7.14%(9/126)、10.32%(13/126)、4.76%(6/126),比较差异均无统计学意义(P均>0.05);锁骨下静脉组的局部血肿形成及夹闭综合征发生率均高于颈内静脉组,差异具有统计学意义(P均<0.05)。结论超声引导下经颈内静脉及经锁骨下静脉输液港植入具有相似的准确性和安全性,但在经锁骨下静脉路径时,需警惕局部血肿形成及夹闭综合征等并发症的发生。

Objective To explore the application effect of ultrasound-guided implantation of venous access ports through different approaches. Methods A total of 328 cases of patients undergoing ultrasound-guided implantation of venous access ports through internal jugular vein or subclavian vein were selected. The first attempt success rates, incidences of complications and unexpected ports removal rates of different approaches were analyzed. Results The first attempt success rates of internal jugular vein group and subclavian vein group were respectively 95.05% （192/202） and 93.65% （118/126）, without statistical differences （χ2 = 0.293, P = 0.588）. The total, perioperative, long-term incidence of complications and unexpected ports removal rate of internal jugular vein group were respectively 11.39% （23/202）, 3.96% （8/202）, 7.43% （15/202） and 4.95% （10/202）, while those of subclavian vein group were respectively 17.39% （22/126）, 7.14% （9/126）, 10.32% （13/126） and 4.76% （6/126）, without statistical differences （all P 〉0.05）. The incidence of hematoma and pinch-off syndrome of subclavian vein group were both higher than those of internal jugular vein, with statistical differences （both P 〈0.05）. Conclusions Ultrasound-guided implantation of venous access ports through internal jugular vein and subclavian vein are both reliable and safe. But the hematoma and pinch-off syndrome should be paid attention when using the subclavian vein approach.