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先天性心脏病患儿微创技术体外循环期间经皮颈内静脉插管:手术技术与结果

Percutaneous internal jugular venous cannulation for extracorporeal circulation during minimally invasive technique in children with congenital heart disease: operative technique and results.

作者信息

Vida Vladimiro L, Tiberio Ivo, Gallo Michele, Guariento Alvise, Suti Emirjeta, Pittarello Demetrio, Stellin Giovanni

机构信息

Unit of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy -

出版信息

Minerva Pediatr. 2016 Oct;68(5):341-7. Epub 2015 Mar 18.

PMID:25784208
Abstract

BACKGROUND

The aim of this study was to evaluate the safety and efficacy of the percutaneous cannulation of the internal jugular venous (PCIJV) for extracorporeal circulation during minimally invasive cardiac surgery (MICS) in children with simple congenital heart disease.

METHODS

From September 2007, 83 children (<16 years) underwent PCIJV for extracorporeal circulation. Primary outcome of the study was to evaluate the safety and advantages of PCIJV technique. Technical steps and pitfalls of PCIJV technique are described.

RESULTS

Median age at surgery was 9 years (range 3.5-16 years) and median body weight was 31 kilograms (range 13-72 kilograms); 32 patients (40%) had a body weight less than 30 kilograms. The PCIJV was achieved with a 14 French cannula in 61 pts (73%), with a 17 Fr cannula in 22 (23%). The PIJVC was judged difficult in 2 patients (2.4%); in both of them cannulation was achieved at a different venous site There were no procedure-related complications and no flow disturbances during the extracorporeal circulation.

CONCLUSIONS

The PCIJV during MICS is an effective and reproducible technique for achieving peripheral CPB in children with simple CHDs. We progressively expanded the use of this technique in smaller children and this allows us to further minimize surgical trauma without experiencing venous drainage's problems.

摘要

背景

本研究旨在评估在患有单纯先天性心脏病的儿童进行微创心脏手术(MICS)期间,经皮颈内静脉插管(PCIJV)用于体外循环的安全性和有效性。

方法

从2007年9月起,83名16岁以下儿童接受了用于体外循环的PCIJV。该研究的主要结果是评估PCIJV技术的安全性和优势。描述了PCIJV技术的技术步骤和陷阱。

结果

手术时的中位年龄为9岁(范围3.5 - 16岁),中位体重为31千克(范围13 - 72千克);32名患者(40%)体重小于30千克。61例患者(73%)使用14号法国套管实现了PCIJV,22例(23%)使用17号法国套管。2例患者(2.4%)的经皮颈内静脉插管术被判定困难;在这两例中,均在不同的静脉部位成功插管。体外循环期间没有与手术相关的并发症,也没有血流紊乱。

结论

在MICS期间,PCIJV是一种有效且可重复的技术,可用于患有单纯先天性心脏病的儿童实现外周体外循环。我们逐渐在更小的儿童中扩大了该技术的应用,这使我们能够在不出现静脉引流问题的情况下进一步减少手术创伤。

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