Ricard J, Canarelli J P, Postel J P, Quintard J M, Bernard F
Service de Chirurgie Pédiatrique, CHU Amiens.
Chir Pediatr. 1989;30(1):25-9.
Four cases of vascular injuries of subclavian artery in children are reported after 414 percutaneous catheterization between 1980 and 1986. The first case reported is a 2 month old child with a right subclavian aneurysm after punction, witch be treated by a successful resection-anastomosis. Three others children, 12, 13, and 14 years old have been catheterized by a jugular approach for one and by a subclavian approach in the others. In this three cases the diagnosis was made by an important hemothorax requiring a drainage. In one case, the recovery was obtain only by drainage, in the two others a surgical approach was necessary with a suture of the subclavian artery in one and a ligation in the other case. The diagnosis of these vascular lesion is difficult = an hemothorax must be drained quickly and a persistent bleeding require a surgical treatment by a cervical route associated with a cleidotomy for the subclavian control. All catheterization in children must be realized by operator with a good practice and an adapted material. The jugular route must be preferred to the subclavian route in children.
报告了1980年至1986年间414例儿童经皮导管插入术后发生的4例锁骨下动脉血管损伤。报告的第一例是一名2个月大的儿童，穿刺后出现右锁骨下动脉瘤，经成功的切除-吻合术治疗。另外三名儿童，年龄分别为12岁、13岁和14岁，其中一名通过颈内静脉途径进行导管插入，另外两名通过锁骨下途径进行导管插入。在这三例中，诊断均为大量血胸需要引流。其中一例仅通过引流恢复，另外两例则需要手术治疗，一例对锁骨下动脉进行缝合，另一例进行结扎。这些血管病变的诊断困难，必须迅速引流血胸，持续出血需要通过颈部途径进行手术治疗，并联合锁骨切开术以控制锁骨下动脉。所有儿童的导管插入术必须由经验丰富的操作人员使用合适的材料进行。儿童应首选颈内静脉途径而非锁骨下途径。
