三种方式引导植入静脉输液港的比较

Comparison of three guidance placement of implantable venous access port

目的:比较DSA、CT、B超3种方式引导下植入式静脉输液港的应用。方法:回顾性分析我院2017年4月至2018年2月行颈内静脉输液港植入共82例病人的临床资料,其中DSA引导组30例,CT引导组22例,B超引导组30例,比较其手术时间、辐射剂量及并发症发生情况。结果:3组病人经颈内静脉植入输液港的穿刺成功率均为100%。CT引导组手术时间显著长于其他两组(P<0.05)。该组接受的辐射剂量也显著高于其他两组(P<0.05)。DSA引导组各有1例出现气胸、血胸和颈部牵拉感。CT引导组1例出现颈部牵拉感。B超引导组中各有1例出现颈部牵拉感和颈部穿刺点导管折角。3组在并发症发生方面无统计学差异(P>0.05)。3组无1例出现感染、气体栓塞、心律失常等严重并发症。结论:DSA引导下行颈内静脉PORT植入,其操作便利、耗时短、辐射剂量少,但盲视下行颈内静脉穿刺存在一定风险。

Objective To compare digital subtraction arteriography（DSA） guidance,CT guidance and B-ultrasound guidance of implantable venous access port placement.Methods The clinical data of 82 cases with implanted internal jugular venous access port including 30 cases in DSA-guided group,22 cases in CT-guided group and 30 case in Bultrasound-guided group from April 2017 to February 2018 in our hospital were analyzed retrospectively.Operation time,radiation dose and complications were compared.Results The placement of port was successful in all the patients.The operation time of cases in CT-guided group was significantly longer and the radiation dose higher than in the other two groups（P〈0.05）.Several complications were observed in three groups.Pneumothorax in one case,hemothorax in one case and pulling sensation of neck in one case were found respectively in DSA-guided group.Only pulling sensation of neck discomfort was found in one case of CT-guided group.The pulling sensation of neck was present in one case and the catheter with angle formed in another case in B-ultrasound guided group.There was no significant difference statistically in complications among three groups（P〈0.05）.Local and systemic infection,gas embolism,arrhythmia and other serious complications were all not seen in three groups.Conclusions The placement of an internal jugular vein port through DSA guidance is convenient,time-saving and low radiation exposure,and there is risk of internal jugular vein puncture without guiding.