食管癌患者手术期间外周静脉穿刺中心静脉导管自发迁移至奇静脉。
Spontaneous migration of a peripherally inserted central catheter into the azygos vein in esophageal cancer patients during surgery.
作者信息
Zhang Hanfeng, Jiang Bin, Zhou Hong, Qin Ying, Wang Guorong
机构信息
Department of Radiotherapy, Cancer Hospital of Sichuan Province, Chengdu - China.
Department of Thoracic Surgery, Cancer Hospital of Sichuan Province, Chengdu - China.
出版信息
J Vasc Access. 2015 Nov-Dec;16(6):537-9. doi: 10.5301/jva.5000432. Epub 2015 Jun 22.
INTRODUCTION
A peripherally inserted central catheter (PICC) is widely used for long chemotherapy regimens or total parenteral nutrition. However, spontaneous migration of the catheter into the azygos vein after satisfactory initial placement has occurred in rare cases.
METHODS
We discuss three such cases in esophageal cancer patients.
RESULTS
In two patients, the migrated catheters were found during surgery and were repositioned without complications. However, in the third case, the migrated catheter had to be removed to avoid severe complications, as the catheter and the azygos vein were ligatured during operation without notice.
CONCLUSIONS
Migrations might be related to the material properties of silicone PICCs, the short insertion length, the left-sided placement, the changes of thoracic pressure and the intraoperative traction by thoracic surgeons. In conclusion, we recommend routine checks before cutting off the azygos vein during the operations for esophageal cancer patients with left-sided PICCs.
引言
外周静脉穿刺中心静脉导管（PICC）广泛应用于长期化疗方案或全胃肠外营养。然而，在极少数情况下，导管在初始放置满意后会自发迁移至奇静脉。
方法
我们讨论了3例食管癌患者出现这种情况的病例。
结果
在2例患者中，迁移的导管在手术中被发现并重新定位，未出现并发症。然而，在第3例中，由于手术中未注意到导管与奇静脉被结扎，不得不移除迁移的导管以避免严重并发症。
结论
导管迁移可能与硅胶PICC的材料特性、插入长度短、左侧置管、胸内压力变化以及胸外科医生的术中牵引有关。总之，对于左侧置有PICC的食管癌患者，我们建议在手术切断奇静脉前进行常规检查。
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