准分子激光鞘技术拔除导线的初步临床应用

Initial experience of cardiac lead extraction with laser sheaths in China

目的 评价准分子激光鞘拔除起搏器导线的安全性和有效性.方法 回顾性分析中国医学科学院阜外医院2016年8月至2017年1月应用准分子激光鞘拔除导线的6例患者资料,总结导线的植入时间、感染时间,以及导线的拔除成功率、锁定情况、手术相关并发症等.结果 本研究共纳入起搏器囊袋感染患者6例（女1例）,中位年龄49（23~75）岁.使用激光鞘拔除导线13根（心房导线6根,心室导线7根）,完全拔除导线10根（76.9%）,部分拔除3根（23.1%）.9根（69.2%）导线可以被锁定钢丝全程锁定;4根（30.8%）未全程锁定,在拔除过程中断裂,后使用下位法拔除.无术中并发症发生,中位导线植入时间12（6~26）年、感染时间2.5（0.5~12.0）个月.结论 准分子激光鞘技术可以安全有效地拔除导线.当导线结构完整,可以被锁定钢丝全程锁定时,有利于激光鞘顺利推进并彻底拔除导线.

Objectives To investigate the safety and effectiveness of laser sheaths in lead extraction in patients with infected or malfunctioned leads. Methods From August 2016 to January 2017,13 pacing leads were removed in 6 patients due to pocket infection using laser sheaths in Fuwai hospital.Data on procedural suc-cess rates,intra-and post-operative outcomes,as well as mortality were collected and analyzed retrospectively. Results The median age was 49 years old（range 23-75,female 1）.A total of 13 leads were removed including 6 atrial leads and 7 ventricular leads.The leads were completely removed in 10/13（76.9%）cases,and 3/13 （23.1%）were partially removed.The median duration of implantation and pocket infection was 12 years old （range 6-26）and 2.5 month（range 0.5-12）,respectively.Nine（69.2%）stylets were successfully inserted and locked at the tip of lead.No severe complications were observed in this series.No death occurred during the 30-day follow-up. Conclusion The leads can be safely and completely extracted using a laser sheath when the stylet placed at the tip of lead with a high procedural success.