超声联合X线引导下胸壁输液港精准植入的临床研究

Ultrasound combined with X-ray-guided precise implantation of totally implantable access ports in the chest wall

目的观察超声联合X线引导下胸壁输液港精准植入的成功率、手术时间和并发症发生情况。方法选取梅州市人民医院2015年1月至2018年8月行静脉输液港植入患者623例为研究对象,其中320例在超声联合X线引导下精准植入输液港为A组,采用个体化选择颈内静脉或锁骨下静脉入路,以彩色多普勒超声引导穿刺,术中C型臂X线机确定导管尖端位置。另303例以传统方式植入输液港为B组,采用体表解剖标志定位行锁骨下静脉穿刺入路,以经验方法估计置入导管的深度。比较两组的首次植入成功率、手术时间及并发症(气胸、血胸、导管异位、导管尖端位置不佳、皮囊感染、血栓形成等)。结果两组基线资料差异无统计学意义(P>0.05)。首次植入成功率:A组为100.0%(320/320),B组为93.1%(282/303),两组差异有统计学意义(χ^(2)=22.95,P<0.01)。A组手术时间(26.48±5.49)min,明显短于B组的(35.51±14.37)min(t=-10.25,P<0.01)。A组2例患者并发气胸,均保守治疗后治愈;6例血栓形成;并发症发生率2.5%(8/320)。B组67例患者出现并发症(9例气胸、4例异位二次调管、17例导管尖端位置不佳、36例血栓形成、1例皮囊感染),并发症发生率22.11%(67/303)。两组并发症发生率差异有统计学意义(χ^(2)=56.53,P<0.01)。B组气胸9例中行胸腔闭式引流后治愈6例;4例导管异位者均异位至颈内静脉,行二次手术调整。结论超声联合X线引导下胸壁输液港精准植入术首次成功率达100.0%,并发症少,手术时间短,患者舒适度高,是一种安全、高效的手术方式。

Objective To investigate the success rate,operation time and complications of ultrasound combined with X-ray-guided precise implantation of totally implantable access port(TIAP)in the chest wall.Methods A total of 623 patients who underwent implantation of totally implantable venous access ports in the chest wall in Meizhou People's Hospital,China between January 2015 and August 2018 were included in this study.In group A(n=320),jugular or subclavian access ports were precisely implanted in the chest wall under the guidance of ultrasound combined with X-ray.During the surgery,color Doppler ultrasound was used to guide the puncture and a C-arm machine was used to locate the position of catheter tip.In group B(n=303),venous access ports were implanted using the conventional method.Subclavian vein puncture was performed using anatomic landmarks and the depth of catheterization was estimated by experience.The success rate of the first implantation,operation time,and complications(pneumothorax,hemothorax,catheter displacement,poor position of catheter tip,skin infection,and thrombosis)were compared between the two groups.Results There were no statistical differences in baseline data between the two groups(P>0.05).The success rate of the first implantation in the group A was significantly higher than that in the group B[100%(320/320)vs.93.06%(282/303),χ^(2)=22.95,P<0.01].The operation time in the group A was significantly shorter than that in the group B[(26.48±5.49)minutes vs.(35.51±14.37)minutes,t=-10.25,P<0.01].In group A,2 patients developed pneumothorax and healed after conservative treatment,6 patients had thrombosis,and the incidence of complications was 2.5%(8/320).In group B,complications occurred in 67 patients,including pneumothorax in 9 patients,poor catheter tip position in 17 patients,thrombosis in 36 patients,and skin infection in 1 patient,and the incidence of complications was 22.11%(67/303).There was significant difference in the incidence of complications between the two groups(χ^(2)=56.53,P<0.01).In group B,6 out of 9 patients developing pneumothorax were healed after closed thoracic drainage,and 4 patients underwent a secondary surgery because of catheter displacement into the internal jugular vein.Conclusion Precise implantation of venous access ports in the chest wall guided by ultrasound combined with X-ray has the advantages including 100%success rate of first precise implantation,few complications,short operation time,high comfort,safety and efficacy.