肝右后下静脉在右侧肾上腺静脉取血中的干扰及规避方法

The interference of inferior right hepatic vein in right adrenal vein sampling and its avoidance method

目的探讨肝右后下静脉(IRHV)在右侧肾上腺静脉取血(AVS)中的干扰及规避方法。方法收集2018年6月至2021年1月浙江大学医学院附属第二医院110例AVS患者资料,分析有无IRHV组的右侧AVS差别。将右侧取血失败、插管时间>30 min、导管反复脱出、血管误认、多次取血等定义为右侧AVS困难。结果共有患者62例(56.4%)术中发现IRHV,有IRHV和无IRHV组的右侧AVS困难病例比例分别为17.7%(11/62)、2.1%(1/48),取血成功率为96.8%(60/62)、97.9%(47/48),成功插管时间为(9.54±1.55)、(7.57±1.96)min,并发症发生率为8.1%(5/62)、4.2%(2/48)。两组比较,除困难病例比例差异有统计学意义(P=0.021)外,其余无统计学意义(均P>0.05)。IRHV的干扰:(1)可能被误认成右侧肾上腺静脉(RAV),规避方法在于熟悉IRHV的影像;(2)可能与RAV紧贴或共干,导致插管困难,规避方法在于熟悉两者的解剖关系;(3)可能造成取血不稳定或血液被稀释,采用同轴导丝技术可规避。结论IRHV在右侧AVS的识别、插管、取血环节均存在干扰,但对掌握规避方法的经验丰富术者结果无明显影响。

Objective To investigate the interference of inferior right hepatic vein(IRHV)in right adrenal vein sampling(AVS)and the avoidance methods.Methods Data of 110 patients undergoing AVS at the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2018 to January 2021 were collected.The differences of right AVS in the groups with or without IRHV were analyzed.Right AVS failure,intubation time>30 min,repeated detachment of catheter during blood collection,misidentification of blood vessel,and the need to blood collection again according to the fast intraprocedural cortisol testing were defined as right AVS difficulty.Results A total of 62 patients(56.4%)were identified with IRHV.The rates of right AVS difficulty in the group with IRHV and without IRHV were 17.7%(11/62)and 2.1%(1/48)respectively with a significant statistical difference(P=0.021).In groups with IRHV and without IRHV,the right AVS success rates were 96.8%(60/62),97.9%(47/48),the time of successful intubation were(9.54±1.55),(7.57±1.96)min,and the complication rates were 8.1%(5/62),4.2%(2/48),respectively,the differences were not statistically significant(all P>0.05).The interference of IRHV were:(1)it might be mistaken for right adrenal vein(RAV),and the way to avoid it was to be familiar with image of IRHV;(2)it might be close to or shared drainage with RAV,leading to difficulty in intubation,and the way to avoid it was to be familiar with the anatomical relationship between IRHV and RAV;(3)it might cause instability of blood collection or blood dilution,and the way to avoid it was the application of coaxial guide wire-catheter technique.Conclusions IRHV interferes with the identification,intubation and blood collection of right AVS,but has no significant effect on outcome for experienced operators who have mastered the avoidance methods.