Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 411-764, Republic of Korea.
Eur J Radiol. 2009 Dec;72(3):494-8. doi: 10.1016/j.ejrad.2008.09.015. Epub 2009 Feb 5.
To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches.
The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n=7), operation scar (n=6), radiation scar (n=5), failure of low jugular vein puncture (n=2), and abnormal course of right subclavian artery (n=1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port.
The procedure-related complications were all minor (n=14, 8.6%) in both groups; hematoma (n=4, 2.8% in low jugular puncture group and n=1, 4.8% in high jugular puncture group, p=0.6295), air embolism (n=2, 1.4% in low jugular puncture group and n=0 in high jugular puncture group, p=0.5842) and minor bleeding (n=5, 3.5% in low jugular vein puncture group and n=2, 9.5% in high jugular vein puncture group, p=0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p=0.0349). The reasons for catheter removal were patients' death (59 in low jugular puncture group and 14 in high jugular puncture group, p=0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p=0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p=0.6583). The catheter tip migrated upward an average of 1.86 cm (range, -0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein puncture group and there was no significant difference (p=0.4232).
Right high jugular vein approach can be a feasible alternative to right low jugular vein approach.
回顾性比较经右颈内静脉高位与低位穿刺置入中心静脉输液港的即刻和长期疗效。
本研究纳入 163 例患者（125 例女性，38 例男性；年龄 18-79 岁，平均年龄 53 岁）；142 例患者采用低位颈内静脉入路，21 例患者采用高位颈内静脉入路。高位颈内静脉穿刺的原因包括转移性淋巴结肿大（n=7）、手术瘢痕（n=6）、放疗后瘢痕（n=5）、低位颈内静脉穿刺失败（n=2）和右锁骨下动脉异常走行（n=1）。回顾性分析病历和影像学研究，以确定和比较两组患者的结果和与输液港相关并发症的发生情况。
两组患者的操作相关并发症均为轻微（n=14，8.6%）；血肿（n=4，低位颈内静脉穿刺组 2.8%，高位颈内静脉穿刺组 1 例，4.8%，p=0.6295）、空气栓塞（n=2，低位颈内静脉穿刺组 1.4%，高位颈内静脉穿刺组 0，p=0.5842）和轻微出血（n=5，低位颈内静脉穿刺组 3.5%，高位颈内静脉穿刺组 2 例，9.5%，p=0.2054）。低位颈内静脉穿刺组的平均随访时间为 431 天，高位颈内静脉穿刺组为 284 天。两组间差异有统计学意义（p=0.0349）。导管拔除的原因包括患者死亡（低位颈内静脉穿刺组 59 例，高位颈内静脉穿刺组 14 例，p=0.0465）、疑似感染（低位颈内静脉穿刺组 11 例，高位颈内静脉穿刺组 2 例，p=0.8242）和导管阻塞（低位颈内静脉穿刺组 4 例，高位颈内静脉穿刺组 1 例，p=0.6583）。低位颈内静脉穿刺组导管尖端平均向上迁移 1.86cm（范围，-0.5-5.0cm），高位颈内静脉穿刺组导管尖端平均向上迁移 1.56cm（范围，0-3.6cm），两组间差异无统计学意义（p=0.4232）。
右颈内静脉高位入路可作为右颈内静脉低位入路的可行替代方法。
