经孤立性永存左上腔静脉植入静脉输液港一例

Insertion of a totally implantable venous access port in a patient with isolated persistent left superior vena cava:A case report

永存左上腔静脉(persistent left superior vena cava,PLSVC)伴右上腔静脉(superior vena cava,SVC)缺失,也称为孤立性永存左上腔静脉(isolated persistent left superior vena cava,iPLSVC),是一种相对罕见的先天性体静脉畸形。iPLSVC一般无症状,但会给全植入式静脉输液港(totally implantable venous access port,TIVAP)植入带来临床困难。我们报道1例41岁、需要新辅助化疗联合免疫治疗的男性食管癌患者,在插入TIVAP前,通过多普勒超声、计算机断层扫描(computed tomography,CT)和血管三维重建,发现为PLSVC,右侧SVC缺失。我们选择左侧入路,以左侧锁骨上窝胸锁乳突肌锁骨头外侧切迹作为穿刺点,导管尖端距颈根部穿刺点21.5 cm,尖端位于PLSVC和右心房的交界处,也就是扩张的冠状静脉窦处。输液港植入术顺利,患者术后接受两周期新辅助化疗联合免疫治疗,术后为预防冠状静脉窦及上腔静脉内血栓形成行抗凝治疗,带港期间无导管相关重大并发症。

Persistent left superior vena cava(PLSVC)with absence of right superior vena cava(SVC),also known as isolated PLSVC,is a relatively rare type of congenital body venous malformation.Isolated PLSVC is asymptomatic,however,it will bring clinical difficulties to the implantation of the totally implantable venous access port(TIVAP).We reported a 41 years,male patient with esophageal cancer,who needed neoadjuvant chemoimmunotherapy.Through doppler ultrasonography,computed tomography(CT)and vascular 3D-reconstruction,we found him to be a patient with PLSVC with absence of right SVC before the insertion of TIVAP.Hence,we chose the left approach in which the needle was inserted into the sternocleidomastoid clavicular head lateral notch in left supraclavicular fossa as the puncture point.The depth of the catheter tip from the root of the neck to the puncture point was 21.5 cm and the catheter tip was located at the junction of the PLSVC and the right atrium,at the dilated coronary sinus.The procedure was successful and the patient received expected neoadjuvant chemotherapy combined with immunotherapy after operation,and anticoagulant therapy was performed to prevent thrombosis in coronary sinus and superior vena cava.There was no major catheter-related complication during the period of TIVAP.