经肘静脉与股静脉路径行肾上腺静脉取血的效果比较

Comparison of adrenal venous sampling via elbow vein and femoral vein

目的比较初学者采用经肘静脉与经股静脉路径行分侧肾上腺静脉取血(AVS)的成功率及其安全性。方法 2014年8月—2015年11月间由1名初学者对连续65例原发性醛固酮增多症患者行AVS以明确其分型,分别采用经传统经典的股静脉路径(股静脉组,15例)和经肘静脉路径(肘静脉组,50例)。比较两组的AVS操作时间、左右两侧AVS成功率、X线摄片曝光时间、造影剂用量,以及肾上腺静脉血肿、外周血管穿刺相关并发症发生情况。结果两组间AVS操作时间、X线摄片曝光时间和造影剂用量的差异均无统计学意义(P值均>0.05)。肘静脉组的双侧AVS成功率和右侧AVS成功率均显著高于股静脉组(P值均<0.05),两组间左侧AVS成功率的差异无统计学意义(P>0.05)。肘静脉组有1例患者发生右侧肾上腺血肿,股静脉组无1例患者发生手术并发症,两组间并发症发生率的差异无统计学意义(P>0.05)。结论经肘静脉路径行AVS安全、可行,其右侧AVS成功率显著高于经股静脉路径,更适合于初学者,可作为经股静脉路径的替代方法。

Objective To compare the success rate and safety of adrenal vein sampling （AVS） via elbow vein and femoral vein. Methods From August 2014 to December 2015, 65 consecutive patients diagnosed with primary aldosteronism underwent AVS by one beginner. AVS was performed in 15 patients via femoral vein and in 50 patients via elbow vein. Operation time, success rate of AVS, fluoroscopy time, dosage of contrast and incidence of complications （adrenal hematoma, puncture related complications） were recorded and compared between two groups. Results There was no significant difference in the operation time, fluoroscopy time or contrast consumption between two groups （all P〉0.05）. The successful rate of AVS via bilateral elbow veins was significantly higher than that via bilateral femoral veins （P〈0.05）. The successful rate of AVS via the right elbow vein was also significantly higher than that via right femoral vein （ P〈0.05）. No significant difference was found in the successful rate of AVS between two accesses on the left side （P〉0.05）. Adrenal hematoma occurred in one patient undergoing AVS via elbow vein. There was no significant difference in the incidence of complications between two groups （P〉0.05）. Conclusion AVS via elbow vein is safe and technically feasible, with a higher successful rate of right side AVS compared with femoral vein by beginners.