Khatri V P, Wagner-Sevy S, Espinosa M H, Fisher J B
Department of Surgery at University of California-Davis, Sacramento, California, USA.
Ann Surg. 2001 Feb;233(2):282-6. doi: 10.1097/00000658-200102000-00019.
To validate the authors' published surface landmarks for gaining percutaneous access to the internal jugular vein (IJV), and to determine whether these surface landmarks were altered after neck surgery.
Carotid puncture and pneumothorax continue to be the most frequent mechanical complications of percutaneous IJV venipuncture, particularly when the anterior or posterior approaches are used. The authors' modified technique of IJV venipuncture was associated with a 0.6% complication rate; notably, there were no instances of carotid artery puncture. Determining the accuracy of this method using duplex ultrasound would enhance the technique's applicability and safety. The authors also hypothesized that previous neck surgery would alter the regional anatomy in relation to these surface landmarks for IJV venipuncture.
The authors prospectively evaluated 417 IJVs in 209 consecutive patients undergoing carotid duplex imaging before and after carotid endarterectomy (CEA). Patients who had undergone CEA were enrolled to investigate the effect of neck surgery on IJV anatomy. The opposite, nonoperated side of the neck served as a control for each patient. The position of the IJV in relation to the surface landmarks, the mobility of the IJV on neck rotation, and the size, patency, and relation of the IJV to the carotid artery were evaluated.
Overall accuracy of the surface landmarks for locating the IJV percutaneously was 99% for the control group and 95% for the CEA group. With neck rotation, the IJV was located in a more lateral position in relation to the landmarks that would significantly reduce its accessibility. After neck rotation, it was also noted that the carotid artery moved behind the jugular vein in 85% of the patients in both groups. The mean size of the vein and its patency were similar in both groups.
Duplex imaging validated the accuracy of the surface landmarks for IJV cannulation and documented the adverse effects of neck rotation. IJV anatomy is not altered after CEA.
验证作者发表的用于经皮穿刺颈内静脉（IJV）的体表标志，并确定颈部手术后这些体表标志是否发生改变。
颈动脉穿刺和气胸仍然是经皮颈内静脉穿刺最常见的机械并发症，尤其是采用前路或后路穿刺时。作者改良的颈内静脉穿刺技术并发症发生率为0.6%；值得注意的是，没有发生颈动脉穿刺的情况。使用双功超声确定该方法的准确性将提高该技术的适用性和安全性。作者还推测，既往颈部手术会改变与这些颈内静脉穿刺体表标志相关的局部解剖结构。
作者前瞻性评估了209例连续接受颈动脉内膜切除术（CEA）的患者的417条颈内静脉，这些患者在CEA前后均接受了颈动脉双功成像检查。纳入接受CEA的患者以研究颈部手术对颈内静脉解剖结构的影响。每位患者颈部未手术的对侧作为对照。评估颈内静脉相对于体表标志的位置、颈部旋转时颈内静脉的移动性以及颈内静脉的大小、通畅情况及其与颈动脉的关系。
对照组经皮定位颈内静脉体表标志的总体准确率为99%，CEA组为95%。颈部旋转时，颈内静脉相对于体表标志的位置更偏外侧，这将显著降低其可及性。颈部旋转后，还注意到两组85%的患者颈动脉移至颈静脉后方。两组静脉的平均大小及其通畅情况相似。
双功成像验证了颈内静脉插管体表标志的准确性，并记录了颈部旋转的不良影响。CEA后颈内静脉解剖结构未改变。
