不同深静脉置管方式在乳腺癌术后化疗中的应用

目的比较不同深静脉置管方式在乳腺癌术后化疗中的临床使用效果及相关并发症。方法分别采用经锁骨下静脉、颈内静脉或外周静脉插入中心静脉导管（PICC）,为患者留置深静脉导管于上腔静脉进行乳腺癌术后辅助化疗。结果分别经锁骨下静脉、颈内静脉或外周静脉置管患者为6、9、26例,所有患者均成功置管,三组导管平均留置时间分别为（24.00±2.95）d、（27.17±5.42）d、（145.45±14.45）d,颈内静脉组发生1例置管感染,无一例发生药物渗漏性血管损伤、皮肤损伤及导管堵塞等并发症,均顺利完成化疗。结论经锁骨下静脉或颈内静脉留置时间短,平均费用低,长期使用需定期换管,适用于外周静脉插管困难患者,PICC置管保留时间长,通常一次置管可完成乳腺癌术后6次辅助化疗,定期导管护理可减少导管堵塞、感染等并发症发生,值得临床推广应用。     

前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管的临床应用

目的探讨前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管的可行性及其特点。方法选择需行中心静脉置管的患者120例,随机分为2组(n=60):实验组采用前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管,对照组采用颈内静脉穿刺置管。观察两组穿刺置管的总成功率、一次穿刺成功率、完成时间及并发症。结果试验组总成功率及一次穿刺成功率显著高于对照组(P<0.05或P<0.01),完成时间及并发症显著少于对照组(P<0.05)。结论前斜角肌-锁骨间隙入路行锁骨下静脉穿刺置管是一种高效、安全的中心静脉置管途径。     

脑损伤昏迷患者术后PICC与锁骨下静脉置管的疗效观察

目的：探讨PICC与锁骨下静脉置管在脑损伤昏迷患者术后置管输液治疗的疗效。方法回顾性分析79例行PICC及63例行锁骨下静脉置管输液治疗的脑损伤昏迷患者的临床资料,比较2种治疗方法的一次性置管成功率及导管置入相关并发症的发生率。结果 PICC一次穿刺成功率94.9％（75／79）,锁骨下静脉置管一次穿刺成功率为74.5％（47／63）,差异有统计学意义（P＜0.05）;PICC组发生机械性静脉炎、堵管高于锁骨下静脉组（P＜0.05）,而导管脱落、非计划性拔管的机率小于锁骨下静脉组（P＜0.05）,两组在导管位、导管相关性感染的发生率上差异无统计学意义（ P＞0.05）。结论 PICC与锁骨下静脉置管在脑损伤昏迷患者术后输流治疗中有简单易行、护理方便,留置时长等优点,相比较而言,PICC更具有优势。     

疑难危重患者超声引导下行颈内静脉置管效果观察

目的:观察超声引导对疑难危重患者行颈内静脉置管的效果。方法:选择需行颈内静脉穿刺留置导管的疑难危重患者60例,随机分为观察组和对照组各30例。观察组在超声引导下行颈内静脉穿刺置管,对照组凭体表解剖标志行颈内静脉穿刺置管。比较两组穿刺成功时间、穿刺次数、成功率、误伤动脉或胸膜、动静脉瘘、穿刺部位血肿、多次置管失败等并发症发生情况。结果:观察组穿刺成功时间(7±2)min,显著短于对照组的(16±10)min(P<0.05);一次穿刺成功率93.3%,非常显著高于对照组的30.0%(P<0.01)。观察组并发症发生率非常显著低于对照组(P<0.01)。结论:超声引导在疑难危重患者行颈内静脉置管的效果优于传统方法,穿刺时间短、一次穿刺成功率高、并发症少。     

超声引导改良婴幼儿颈内静脉穿刺置管术的临床研究

目的:探讨超声引导改良婴幼儿颈内静脉穿刺置管术的临床应用价值。材料和方法:随机抽取行先天性心脏病手术的婴幼儿60例分为2组(n=30)。A组:对照组,首选右颈内静脉中路,用20GY形穿刺针穿刺,再经Y型穿刺针置入J形引导钢丝,然后置入中心静脉导管。B组:实验组,在超声引导下用18GBD静脉外套管穿刺,经静脉外套管置入J形引导钢丝,然后置入中心静脉导管。记录两组穿刺置管总成功率、一次穿刺成功率、失败率及并发症。结果:B组总穿刺成功率高于A组(P<0.05),B组一次穿刺成功率显著高于A组(P<0.01),B组的穿刺并发症明显低于A组。结论:超声引导下经18G静脉留置针穿刺置管,大大提高了婴幼儿中心静脉置管的成功率,并降低了并发症的发生率,有很高的临床应用价值。     

颈外静脉与颈内静脉穿刺置管的临床应用比较

目的通过对颈外静脉穿刺置管与颈内静脉穿刺置管进行比较,探讨中心静脉置管的最佳途径。方法对40例需行中心静脉置管病人随机分为两组,分别行颈外静脉穿刺置管与颈内静脉穿刺置管,记录总成功率、一次成功率、并发症发生率、穿刺完成时间。结果采用颈外静脉穿刺置管较颈内静脉穿刺一次进针成功率高,且完成时间短。结论颈外静脉穿刺置管具有操作简便、一次穿刺成功率高、完成时间短、并发症少等优点,与颈内静脉穿刺置管比较,它是一种安全实用的中心静脉置管方法。     

婴幼儿超声辅助下颈内静脉穿刺植入完全植入式静脉输液港评价

目的 探讨超声辅助下颈内静脉穿刺在婴幼儿完全植入式静脉输液港(TIVAP)植入术中的效果.方法 回顾性分析2009年1月至2016年7月在上海交通大学医学院附属儿童医学中心(单中心)治疗的446例TIVAP植入术患儿临床资料,患儿平均年龄1.3岁(4个月～2.8岁).比较传统颈内静脉盲穿刺和超声辅助下颈内静脉穿刺耗时、一次穿刺成功率、穿刺并发症发生率,并作统计学分析.结果 446例患儿中颈内静脉盲穿刺265例,平均需时7.6 min,一次穿刺成功201例(75.85％),发生穿刺并发症15例(5.66％);超声辅助下颈内静脉穿刺181例,平均需时4.2 min,一次穿刺成功176例(97.24％),发生穿刺并发症3例(1.70％).结论 婴幼儿TIVAP植入术时采用超声辅助下颈内静脉穿刺,可缩短手术时间,提高一次穿刺成功率并减少穿刺并发症发生,是一种安全有效、简单可行的技术,值得临床推广.     

通过体表标志估测深静脉导管留置的合适深度

目的探索通过体表标记测量来估测深静脉导管留置合适深度(上腔静脉与右心房的联结处或者气管隆突水平)的简易方法。方法通过左、右颈内静脉,左、右锁骨下静脉通路放置中心静脉导管。穿刺前通过体表标记测量估测导管可能留置深度:穿刺点至右侧锁骨上切迹的距离+右锁骨上切迹至胸骨角距离,其中左锁骨下穿刺时需再减去2.00 cm。穿刺完毕通过床旁胸片检测导管尖端与隆突水平间的距离。尖端高于隆突水平为正,低于隆突水平为负值。结果 86名患者,共100条深静脉纳入研究,各组静脉导管尖端与隆突水平间距离的中位数与四分位数间距:右颈内静脉导管组为0.50 cm与1.10 cm;右锁骨下静脉导管组为0.50 cm与1.30 cm;左颈内静脉导管组为0.60 cm与1.45 cm;左锁骨下静脉导管组为-0.30 cm与1.50 cm。结论通过深静脉估算方法:穿刺点至右侧锁骨上切迹的距离+右锁骨上切迹至胸骨角距离,其中左锁骨下穿刺时需再减去2.00 cm。中心静脉导管的尖端能较可靠的放置于气管隆突水平。     

严重多发伤患者颈内静脉的粗细及其影响因素

目的 了解严重多发伤患者颈内静脉粗细和影响因素，为提高颈内静脉置管成功率提供指导。方法 超声检测50例多发伤患者和27例正常人吸气末、呼气末的颈内静脉截面积，比较2组颈内静脉粗细、影响因素及优势静脉分布情况。结果 多发伤患者颈内静脉较对照组增粗，每侧有3例截面积〈0．40cm^2，优势静脉位于右、左侧分别为37例和13例，与对照组比较，差异无统计学意义。正常组颈内静脉粗细与年龄、身高、体重有关，多发伤患者则与中心静脉压、机械通气相关。结论 多发伤患者双侧颈内静脉不对称，较正常人增粗，穿刺前超声探查和穿刺时使用呼吸机吸气暂停功能有助于提高颈内静脉置管成功率。     

置管体会危重病人中心静脉73例

随着中心静脉置管材料的改进和操作的简化,在危重病人的抢救、监测和营养等方面得到广泛应用。既能减轻患者痛苦又能进行血流动力学监测,指导诊断及治疗,减少护理人员工作量,特别适合危重及慢性病患者。2006年对73例危重病人采取中心静脉置管取得满意效果,体会如下:1临床资料1.1一般资料男性46例,女性27例,年龄34-72岁,右侧颈内静脉置管67例,锁骨下静脉2例,股静脉4例,留置最长96d,最短1d;56例为急诊手术病人。1.2材料国产天地人和科技公司单腔静脉置管包(管径14ga、16ga)、碘伏消毒剂、5%利多卡因、生理盐水等。1.3穿刺方法1.3.1右颈内静脉…     

肝门静脉血流分布的多层螺旋CT研究

目的 运用多层螺旋CT研究脾静脉(SpV)和肠系膜上静脉(SMV)血流在门静脉内和肝内的分布规律,为临床提供相应的影像解剖学数据.方法 回顾性分析在重庆医科大学附属第一医院行上腹部CT平扫及增强检查,动脉期SpV强化而SMV未强化的165例患者的CT资料,观察门静脉主干内SpV与SMV血流的分布情况.分别测量平扫和增强动脉期门静脉左支(LPV)与门静脉右支(RPV)、肝脏左叶与右叶CT值;分析SpV和SMV的血流在门静脉内和肝脏内的分布区域及规律.结果 (1)SpV和SMV血流在门静脉主干内分布情况:分层分布(A组)占61.81％ (102/165);螺旋形分布(B组)占24.85％ (41/165);紊乱分布(C组)占13.33％ (22/165).(2)动脉期LPV的CT值＞RPV占84.24％(139/165),＜RPV占15.76％ (26/165),肝脏左叶CT值＞右叶占85.45％(141/165),＜右叶占14.55％ (24/165);动脉期门静脉左右支、肝脏左右叶CT值差异有显著统计学意义(P＜0.01),平扫无统计学差异(P＞0.05).A、B、C三组组内动脉期门静脉左右支、肝脏左右叶CT值差异有统计学意义(P＜0.05),平扫差异均无统计学意义.结论 SpV和SMV血流在肝门静脉内存在分层分布、螺旋形分布、紊乱分布.84.24％的患者SpV血液主要流入LPV进入肝左叶,SMV血液主要流入RPV进入肝右叶.     

动脉期左侧卵巢静脉显示及其临床意义

目的:分析动脉期左侧卵巢静脉显示与临床相关因素的关系,探讨其临床意义。材料和方法:对93例病人进行CTA检查,使用Toshiba16层CT,层厚1mm,螺距15,造影剂注射速度3.5ml/s或4.0ml/s,注射后26s开始扫描,获得数据进行横断面测量和三维容积成像分析,并与患者的患病情况、生育次数和初潮年龄等因素进行相关分析。结果:三维图像动脉期左侧卵巢静脉的显示率与其直径的大小成正比。动脉期左侧卵巢静脉的显示率与患者有无妇科疾病和生育次数无关,与月经初潮年龄成正比。结论:动脉期左侧卵巢静脉显影,对于无症状经产女性是一种常见的CT征象,可能与初潮年龄相关,但尚未发现疾病相关特异性。     

大脑大静脉畸形的影像学诊断

目的探讨大脑大静脉畸形的影像学诊断价值。资料与方法回顾性分析4例经证实为大脑大静脉畸形的CT、MRI、MRA及DSA的影像学表现。结果4例均显示有大脑大静脉瘤样扩张,瘤巢形成伴周围引流小静脉增多。其中1例表现为天幕动脉瘘入大脑大静脉并动脉瘤形成伴直窦血栓,另3例表现为中线旁区的动静脉畸形引起大脑大静脉瘤样扩张。结论多种影像学检查方法的结合应用对大脑大静脉血管畸形的准确诊断有重要价值。     

Iliac vein compression syndrome: outcome of endovascular treatment with long-term follow-up

Objective

To retrospectively evaluate technical success and long-term outcome of endovascular treatment in patients with iliofemoral deep vein thrombosis (DVT) due to iliac vein compression syndrome (IVCS).

Materials and methods

Between March 2003 and September 2006, 36 consecutive patients (26 women [72%], 10 men, mean age 50 ± 18 years) with acute or chronic iliofemoral deep vein thrombosis due to iliac vein compression syndrome were evaluated for outcome of endovascular treatment. Stent patency was estimated by using the Kaplan–Meier method.

Results

Technical success was achieved in 34 of 36 patients (94%). Six patients with acute or subacute thrombosis had chronic occlusion of the left common iliac vein. Rethrombosis of the stents was observed in four patients. Primary and secondary patency rates were 85 and 94% at 1 year, and 80 and 82% at 4 years. Resolution of symptoms was achieved in 17 of 20 patients (85%) with acute and subacute DVT, and 4 of 16 patients (25%) with chronic DVT. Major complication was seen in one patient (3%).

Conclusion

Intimal changes in the left common iliac vein are mostly chronic in nature even in patients with acute DVT secondary to IVCS. Endovascular treatment with stent placement has a high technical success rate and good long-term patency in the treatment of acute and chronic DVT due to IVCS. Symptomatic improvement seems to be better in patients with acute than chronic DVT due to IVCS.     

Pre- and postprandial alterations of portal venous flow: evaluation with single breath-hold three-dimensional half-Fourier fast spin-echo MR imaging and a selective inversion recovery tagging pulse

PURPOSE: To evaluate the influence of food intake on portal flow using unenhanced magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study population included 29 healthy subjects. A selective inversion recovery tagging pulse was used on the superior mesenteric vein (SMV) and splenic vein (SpV) to study the correlation of tagged blood in the portal vein (PV). MRI was performed before and 60-90 min after a meal. RESULTS: The flow signal from the SMV increased in 97% of the subjects after the meal. Before the meal the portal flow was dominated by flow from the SpV in 59% of the subjects, while it was dominated by flow from the SMV in 76% of the subjects after the meal. The most common distribution pattern of the flow signal from the SpV before the meal was in the central part of the main PV (55%), while it was in the left side (45%) after the meal. The most common distribution pattern of the flow signal from the SMV was in the bilateral sides of the main PV both before and after the meal (62%). CONCLUSION: This technique shows potential for evaluating pre- and postprandial alterations of flow from the SpV and SMV in the PV under physiological conditions.     

Right Gastric Venous Drainage: Angiographic Analysis in 100 Patients

Objective

To evaluate the pattern of right gastric venous drainage by use of digital subtraction angiography.

Materials and Methods

A series of 100 consecutive patients who underwent right gastric arteriography during transcatheter arterial chemoembolization for hepatocellular carcinoma were included in this study. Angiographic findings were retrospectively analyzed with respect to the presence or absence of the right and aberrant gastric veins, multiplicity of draining veins, aberrant right gastric venous drainage sites, and the termination pattern of aberrant right gastric veins (ARGVs). We also compared the relative size of the right and left gastric veins.

Results

A total of 49 patients collectively had 66 ARGVs. The common drainage sites for the ARGVs included the hepatic segment IV (n = 35) and segment I (n = 15). The termination pattern of ARGV could be classified into 4 different types. The most common type was termination as a superficial parenchymal blush formation in small areas without demonstrable portal branches. A statistically significant difference was found for the dominancy of the right gastric vein in gastric venous drainage between the two groups with or without ARGV (p < 0.05, Fisher''s exact test). In the group of patients without ARGV (n = 51), the right gastric vein was equal to (n = 9) or larger than (n = 17) the left gastric vein in 26 patients (26 of 51, 51%).

Conclusion

The incidence of ARGV is higher than expected with four distinct types in its termination pattern. The right gastric vein may play a dominant role in gastric venous drainage.     

经皮血管内激光消融治疗下肢静脉曲张的初步结果观察

目的 :探讨经皮血管内激光消融 (PELA)治疗下肢静脉曲张的初步效果和安全性。方法 :对 16例 2 2条下肢静脉曲张的患者行PELA ,所有患者均有明显的浅静脉曲张 ,同时伴活动后下肢酸胀、疼痛和乏力 ,8例伴肿胀或色素沉着。主要设备为英国DIOMED半导体激光治疗仪。结果 :2 2条患肢经PELA处理即刻静脉造影见大隐静脉主干均闭塞 ,血流中断。 16例患者随访 3～ 12个月 ,原肉眼可见的曲张浅静脉均消失 ,患者不再伴有活动后酸胀、疼痛、乏力或水肿等表现。所有病例无并发症发生。结论 :PELA治疗下肢静脉曲张简单、安全 ,初步结果令人满意。     

Venous variants and anomalies on routine abdominal multi-detector row CT

OBJECTIVE: This study aims to determine the types and prevalence rates of anatomic variations of the hepatic veins, portal vein, inferior vena cava and renal veins, and to establish statistical correlations between various anomalies and frequency differences between male and female using multi-detector row computed tomography (CT). MATERIALS AND METHODS: One thousand one hundred and twenty patients (588 men, 532 women) were evaluated with routine abdominal CT. Frequencies of different variants were noted and compared, and correlations between three categories of variation were tested. RESULTS: In total, 1261 abdominal vein variants and anomalies were identified in 756 (67.5%) of 1120 patients. Six hundred and forty-two hepatic vein variants were detected in 468 (41.8%) patients. One or more inferior right hepatic veins were identified in 356 (31.8%) individuals, and tributary hepatic veins were detected in 147 (13.1%) patients. Portal vein variations and anomalies were observed in 307 (27.4%) cases. The most frequent of these was trifurcation (139 patients, 12.4%). A total of 311 inferior vena cava and renal vein variants were identified in 258 (23%) cases. Six patients (0.5%) exhibited inferior vena cava anomalies, 62 (5.5%) had circumaortic renal veins, 53 (4.7%) had retroaortic renal veins, and 210 (18.8%) had multiple renal veins. CONCLUSION: The prevalence of abdominal vein variations is high, and routine abdominal CT demonstrates these abnormalities very well. The data suggest that hepatic vein variants and multiple right renal veins are more frequent in women than in men, and that hepatic vein variation is correlated with portal vein variation.     

肥胖与非肥胖患者大隐静脉剥脱术后中期效果比较

目的探讨肥胖与非肥胖患者行大隐静脉剥脱术后中期效果的差异。方法选择2012年7月至2013年12月,在承德医学院附属医院因下肢浅静脉曲张并接受大隐静脉剥脱术的患者为研究对象。随机抽取30例肥胖患者(体质量指数≥28 kg/m~2)为肥胖组,以年龄、性别、静脉临床症状严重程度评分(VCSS)及股静脉反流情况为参照,以1∶1匹配非肥胖患者作为非肥胖组。比较两组患者中期随访结果。结果两组患者平均随访13.1个月。肥胖组患者持续穿戴弹力袜的时间短于非肥胖组(P<0.05)。随访中,所有患者VCSS及Aberdeen静脉曲线问卷(AVVQ)评分均较术前有明显改善,但肥胖组AVVQ评分高于非肥胖组(P<0.05);而VCSS评分,两组间比较,差异无统计学意义(P>0.05)。术后股静脉反流的改变情况,两组间比较,差异也无统计学意义(P>0.05)。结论下肢静脉曲张合并肥胖患者行大隐静脉剥脱术后至中期阶段,相应体征及生活质量均能得到明显改善,但患者主观症状的改善程度劣于非肥胖患者,这可能与前者术后穿戴弹力袜的时间相对较短有关。而在股静脉反流的改变方面,肥胖可能并非重要影响因素。     

经皮穿脾门静脉插管技术及其在肝癌介入治疗中的应用

目的 探讨经皮穿脾门静脉插管的可行性、操作技术及其在肝癌介入治疗中的应用价值。材料与方法 选用微创穿刺器械,对23例需行门静脉插管介入治疗而不适合采用经皮穿肝或手术置管等方法的肝癌患者,在X线导引下采用经皮穿脾的方法行门静脉插管。结果 20例（86.96％）患者经皮穿脾门静脉插管获得成功,3例（13.04％）失败（均因脾静脉穿刺失败）。1例（4.35％）患者术后出现急笥腹痛伴腹腔内出血,其余患者无严重并发症。结论 采用经皮穿脾途径行门静脉插管是一种可供选择的门静脉插管方法。