Friedman R A, Van Zandt H, Collins E, LeGras M, Perry J
Baylor College of Medicine, Houston, Texas, USA.
Pacing Clin Electrophysiol. 1996 May;19(5):778-83. doi: 10.1111/j.1540-8159.1996.tb03359.x.
Pacemaker lead removal using interlocking stylets and dilator sheaths has greatly reduced the need for major surgical intervention when lead extraction is required. Previous reports have shown the utility of this method in older patients, most of whom have anatomically normal hearts. The purpose of this study is to report the results of this technique in young patients with and without congenital heart disease. There were 13 patients (M:F = 7:6) aged 9-26 years (median 13). Congenital heart disease was present in 8 of 13 patients. A total of 17 leads required removal; they had been implanted for 54 +/- 24 months (range 19-94). Leads were removed from the left subclavian vein (13) or right subclavian vein (4) only. Seventeen of 18 leads were completely removed and one partially retained in the left subclavian vein. New leads were implanted from the same vein in 11 of 13 patients. Interlocking stylets and metal or flexible dilator sheaths were used in all cases except two. There was one surgical complication: a late wound dehiscence, which was easily managed. No patient required a transfusion, and there was no structural damage noted in any patient on the postoperative echocardiogram. We conclude that lead removal using interlocking stylets and dilator sheaths from the subclavian approach is an effective technique that can be used in young patients, including those with congenital heart disease.
使用联锁探条和扩张器鞘管进行起搏器导线拔除，在需要导线拔除时大大减少了进行大型外科手术干预的必要性。既往报告显示了该方法在老年患者中的实用性，这些患者大多数心脏解剖结构正常。本研究的目的是报告该技术在有或无先天性心脏病的年轻患者中的结果。共有13例患者（男:女 = 7:6），年龄9 - 26岁（中位数13岁）。13例患者中有8例存在先天性心脏病。总共需要拔除17根导线；这些导线已植入54±24个月（范围19 - 94个月）。导线仅从左锁骨下静脉（13根）或右锁骨下静脉（4根）拔除。18根导线中有17根被完全拔除，1根部分保留在左锁骨下静脉。13例患者中有11例从同一静脉植入了新的导线。除2例情况外，所有病例均使用了联锁探条和金属或柔性扩张器鞘管。有1例手术并发症：晚期伤口裂开，很容易处理。没有患者需要输血，术后超声心动图检查未发现任何患者有结构损伤。我们得出结论，经锁骨下途径使用联锁探条和扩张器鞘管进行导线拔除是一种有效的技术，可用于年轻患者，包括那些患有先天性心脏病的患者。
