Rosenthal E
Department of Paediatric Cardiology, Guy's Hospital, London, United Kingdom.
Pacing Clin Electrophysiol. 2000 Sep;23(9):1397-400. doi: 10.1111/j.1540-8159.2000.tb00969.x.
Pectoral placement of pacemaker generators, combined with use of a redundant intravascular lead portion, reduces the need for endocardial lead advancement during growth in children. While the use of small generators and submuscular pockets has contributed to cosmetic acceptability, the conventional subclavicular incision may occasionally form a keloid scar that is unacceptable in young girls. A modified implantation technique was used in five girls (age 2.6-13.3 years) during implantation of VDD (n = 2), VVIR (n = 2), and DDDR (n = 1) pacemakers. A 5-cm incision was made in the axilla along the line of the pectoralis major and dissection was continued below the muscle to create a pocket for the generator. Subclavian vein puncture was performed from the axillary incision and beneath the pectoralis major muscle using standard or extra long needles with a needle guard. Peel away sheaths were used for lead positioning. The generator was placed in the submuscular pocket and the wound closed with absorbable sutures. At follow-up, pacemaker function was excellent and neither the scars nor pacemakers were visible from the front. In conclusion, the axillary incision with direct subclavian vein puncture from below the pectoralis major muscle offers the advantages of pectoral pacemaker implantation through a single cosmetic incision.
起搏器发生器置于胸肌部位，结合使用冗余的血管内导线部分，可减少儿童生长过程中心内膜导线推进的需求。虽然使用小型发生器和肌下囊袋有助于美观，但传统的锁骨下切口偶尔可能形成瘢痕疙瘩，这在年轻女孩中是不可接受的。在植入VDD（n = 2）、VVIR（n = 2）和DDDR（n = 1）起搏器期间，对5名女孩（年龄2.6 - 13.3岁）采用了改良植入技术。沿胸大肌线在腋窝做一个5厘米的切口，在肌肉下方继续解剖以创建一个用于放置发生器的囊袋。使用标准或超长带针套的针从腋窝切口并在胸大肌下方进行锁骨下静脉穿刺。使用可剥离鞘进行导线定位。将发生器置于肌下囊袋中，伤口用可吸收缝线缝合。随访时，起搏器功能良好，从正面既看不到瘢痕也看不到起搏器。总之，通过胸大肌下方直接进行锁骨下静脉穿刺的腋窝切口，具有通过单一美观切口植入胸肌起搏器的优点。
