应用机械切割鞘拔除导线的初步临床经验

目的 探讨应用机械切割鞘拔除导线的安全性及有效性.方法 入选2013年6月至2014年6月因起搏系统感染在鼓楼医院就诊,行起搏系统移除及导线拔除术的患者,分别采用套叠式扩张鞘及机械切割鞘（Evolution,美国Bloomington公司）拔除导线,比较2种方法的有效性及安全性.结果 24例患者入选,拔除导线47根,其中心房导线16根,心室导线31根.24例患者中采用机械切割鞘拔除的6例.同传统的套叠式扩张鞘相比,采用机械切割鞘的6例患者手术时间[（2.1＆#177;1.2）h对（1.5＆#177;0.9）h,P=0.04]及X线曝光时间[（16.5＆#177;6.2） min对（8.7＆#177;4.2） min,P=0.04]均明显缩短,14根导线均成功拔除.传统的套叠式扩张鞘拔除的33根导线中,1根因植入时间较长未能完全移除,心腔内有部分导线头端残留.结论 与传统的套叠式扩张鞘相比,机械切割鞘缩短了手术时间及X线曝光时间,临床应用的初步经验认为该技术安全、有效.

Preliminary experience in extraction of pacemaker leads with Evolution mechanical dilator sheath

Objective Observe the safety and effectiveness of lead extraction with the Evolution mechanical dilator sheath.Methods From June 2013 to June 2014,patients with cardiac device infection undergoing lead extraction with different methods were enrolled in this study.The procedures were performed with mechanical sheaths or Evolution system to compare the safety and effectiveness.Results Twenty-four patiens were enrolled.47 leads （16 in atrial,31 in ventricular）were extracted and 14 leads were removed with Evolution mechanical dilator sheath.Compared with mechanical sheaths,Evolution system reduced the operation time [（2.1±1.2） h vs.（1.5±0.9） h,P =0.04] and X-ray time[（16.5±6.2） min vs.（8.7±4.2） min,P=0.04].Complete procedural success with Evolution system was achieved in 14 leads.All of the patients discharged uneventfully without a major complication.Conclusion Our experience confirms that the mechanical technique with Evolution system reduce the operation time and X-ray time,the technique is an effective and safety method for lead extraction.