- 期刊
Use of Stone basket for Removal of Fractured Totally Implanted Central Venous Device Catheters
使用結石籃網移除斷裂的植入式人工血管座導管
摘要
植入式人下血管座(totally implanted central venous device, TLCVD)導管斷裂是極爲少見的併發症。病患通常須接受介入性治療取出斷裂的導管，然後再接受一次手術取出皮下的人工血管座或再植入一個新的植入式人工血管座。結石籃網(stone basket)的前端設計類似套環。結石籃網最初是設計用取出膽道結石或泌尿道結石。我們相信結石籃網同樣適用於取出血管中斷裂的導管。 自2005年12月至2007年3月，共有十三位病人偶然問於手術室發現植入式人工血管座的導管斷裂。其中兩位病人，我們選擇右股靜脈作爲血管途徑，而其餘十一位選擇右大隱靜脈作爲血管途徑。關閉的結石籃網在螢光攝影(fluoroscope)導引下接近斷裂的導管尖端，之後打開結石籃網並抓住斷裂導管，最後將結石籃網連同斷裂導管一同拉出。而殘存於皮下的注射座則於同次手術取出或視臨床需要再次植入新的植入式人工血管座。上述所有的步驟均在手術室內一次完成。 所有斷裂的導管均順利取出而沒有任何併發症。 結石籃網可適用於血管腔內斷裂導管的移除。外科醫師可在一次的手術之中移除斷裂的導管及殘存於皮下的注射座。
關鍵字
無資料並列摘要
Objectives: Fracture of a totally implanted central venous device (TICVD) catheter is rare. The patient needs to receive intervention for the fractured catheter retrieval and is then operated upon once again for implantable port removal or implantation of a new one. A stone basket is a form of snare. We believe that the stone basket is as effective for retrieval of fractured catheters as for traditional bililary and ureteral lithotripsy. Methods: From December 2005 to March 2007, thirteen patients were found to have a fracture of totally implanted central venous device catheters in the operating room incidentally. We chose the right femoral vein (n=2) or right great saphenous vein (n=11) for vascular access. The closed stone basket was advanced, and it captured the fractured catheter under fluoroscopic guidance. Then the stone basket was pulled back with the trapped catheter. The residual subcutaneous port was removed at the same time. Besides, another new TICVD could be implanted in the same operation if needed. All the procedures were completed in the operating room. Results: All the fractured catheters (n=13) were retrieved successfully without any complication. Conclusion: The stone basket is capable of intravascular broken catheter retrieval. Surgeons can use the stone basket to retrieve the fractured catheter and remove the residual port in a single operation.
延伸閱讀
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