腔内介入治疗血管内异物：附4例报告并文献复习

背景与目的:血管内异物的发生在临床工作中比较常见,尤其是针对医源性因素所引起的血管内异物更为常见。随着医疗有创操作的增加,医源性血管内异物的发生也逐渐增多,这也可能会导致患者出现严重的并发症。因此针对血管内异物的发生、发展及其诊治思路也引起了临床医生更为广泛的关注和探讨。所以,为了能够更好的诊治此类患者,保障患者的就诊安全,本文将立足于我中心近2年血管内异物的诊治经过,以及结合现有文献的报道进行综合分析和讨论,以期对临床上类似患者的诊治提供科学的理论依据和经验分享。方法:收集我中心近2年诊治的4例血管内异物患者的临床资料,对其异物的来源及特点、手术的过程及经验等进行回顾性的分析和梳理。对现有国内外针对此类疾病的文献报道进行检索,并对相关文献进行学习和总结。结果:4例患者均属于医源性的血管内异物,其中1例是经外周穿刺中心静脉导管(PICC)置管过程中导丝脱落引起,2例是由于PICC导管的断裂引起,另外1例是由于腔内介入手术对腹主动脉穿透性溃疡栓塞过程中弹簧圈部分脱落至腹主动脉腔内引起。4例患者均无异物相关的临床表现,均在介入下通过单弯导管配合鹅颈圈套器的方式成功取出异物,且异物完整性可;术后患者均恢复良好,无任何异物及手术相关并发症的发生。结论:在临床工作中,尽管无法完全避免血管内异物的发生,尤其是医源性的因素,但应采取有效的预防措施。针对已发生的血管内异物,为了尽可能的降低异物所带来严重并发症的风险,及时、有效的治疗方案显得极其重要。腔内介入治疗作为血管内异物的首选治疗方法,具有异物回收率高、手术风险低、并发症少等独特的优势,而且其疗效也已经得到了证实。除此之外,腔内介入手术过程中还需具有多种可选择适宜的介入器械以及经验丰富的手术操作医师。

Endovascular interventional treatment of intravascular foreign bodies: a report of 4 cases and literature review

Background and Aims: The occurrence of intravascular foreign bodies is relatively common in clinical practice, especially the intravascular foreign bodies caused by iatrogenic factors. With the increase of number of medical invasive procedures, the occurrence of iatrogenic intravascular foreign bodies is also increasing, which may lead to serious complications in patients. Therefore, the occurrence and development of intravascular foreign bodies as well as their diagnosis and treatment have also attracted attention and discussion from clinicians. Therefore, in order to optimize the diagnosis and treatment of such patients, and ensure the safety of the patients, this study conducted a comprehensive analysis and discussion based on the experience in diagnosis and treatment of intravascular foreign bodies in our department in the past two years, combined with the existing literature reports, so as to provide scientific theoretical basis and experience sharing for the diagnosis and treatment of similar cases in clinical practice.  Methods: The clinical data of 4 patients with intravascular foreign bodies diagnosed and treated in our center in the past two years were collected, and the sources and characteristics of foreign bodies, surgical procedures and experience were retrospectively analyzed and sorted out. The existing domestic and foreign literature reports concerning such diseases were retrieved, and then were reviewed and summarized. Results: All the 4 patients had iatrogenic intravascular foreign bodies, which in one case was caused by the guide wire detachment during placement of the peripherally inserted central catheter (PICC), in two cases were caused by the fracture of the PICC catheter, and in another case was causes by undesirable detachment of the coils in the abdominal aortic lumen during endovascular embolization for a penetrating aortic ulcer. None of the four patients had clinical manifestations related to foreign bodies. All the foreign bodies were successfully removed by using a single-bent catheter and a gooseneck snare under interventional approach, and the integrity of each foreign body was acceptable. All patients recovered well after operation without any foreign body and operation-related complications. Conclusion: In clinical practice, the occurrence of intravascular foreign bodies cannot be completely avoided, especially those caused by iatrogenic factors, and effective preventive measures should be taken. For the already occurred intravascular foreign bodies, timely and effective treatment is extremely important to reduce the risk of serious complications caused by foreign bodies. As the preferred treatment for intravascular foreign bodies, endovascular interventional therapy has the unique advantages of high retrieval rate, low surgical risk and fewer complications, and its efficacy has also been proven. In addition, a variety of appropriate interventional instruments should be selected and experienced surgeons are necessary during endovascular interventional procedures.