经腋静脉完全植入式静脉输液港术中导管异位的影像学因素分析

doi:10.13418/j.issn.1001-165x.2025.6.03

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中国临床解剖学杂志 ›› 2025, Vol. 43 ›› Issue (6) : 640-644. DOI: 10.13418/j.issn.1001-165x.2025.6.03

断层影像解剖

经腋静脉完全植入式静脉输液港术中导管异位的影像学因素分析

陈浩¹，陈露²*，张寅¹*

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Radiographic factor analysis of catheter malposition during totally implantable venous access port placement via the axillary vein

Chen Hao¹, Chen Lu²*, Zhang Yin¹*

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摘要

目的探讨经右侧腋静脉完全植入式静脉输液港（TIVAP）术中导管头端异位的发生情况，并分析术前胸部磁共振成像（MRI）所测血管解剖参数与异位的相关性，为术前风险评估及术中精准置管提供依据。方法回顾性纳入2018年5月至2019年12月在南京大学医学院附属鼓楼医院甲乳外科行右侧腋静脉TIVAP植入的乳腺癌女性患者165例，术中均采用腔内心电图监测P波定位导管头端。根据导管是否异位分为异位组与对照组，术前MRI测量锁骨下静脉（A）、颈内静脉（B）、头臂静脉（C）直径及锁骨下/颈内静脉夹角（α角）、锁骨下/头臂静脉夹角（β角）。比较两组影像学参数差异，分析其与导管异位的相关性。结果 TIVAP置入成功率为100%（165/165），术中导管头端异位率为14.5%（24/165），均异位于同侧颈内静脉。异位组患者的颈内静脉直径（12.31±1.60） mm及α角（100.8±7.7）°显著大于对照组（10.91±1.63） mm和（91.67±4.12）°，差异具有统计学意义（P<0.05）。两组在A、C及β角等参数上的差异无统计学意义（P>0.05）。结论经右侧腋静脉TIVAP植入术中，颈内静脉直径增大和锁骨下/颈内静脉夹角扩大是导管头端异位的危险因素。术前MRI定量测量静脉结构可为术中导管走向提供预测依据，有助于筛查导管异位高风险个体，指导个体化置管策略，提高手术安全性和定位精准度。

Abstract

Objective To investigate the incidence of catheter tip malposition during totally implantable venous access port (TIVAP) implantation via right axillary vein and analyze the correlation between preoperative magnetic resonance imaging (MRI)-measured vascular anatomical parameters and malposition, thereby providing evidence for preoperative risk assessment and precise intraoperative catheter placement. Methods 165 female breast cancer patients who underwent right axillary vein TIVAP implantation at the Department of Breast Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital from May 2018 to December 2019 were enrolled in this retrospective study. Intracavitary electrocardiogram monitoring with P-wave localization was used to position the catheter tip in the operation. Patients were divided into a malposition group and a control group based on catheter malposition status. The diameters of the subclavian vein (A), internal jugular vein (B), and brachiocephalic vein (C), as well as subclavian/internal jugular vein angle (α angle) and subclavian/brachiocephalic vein angle (β angle) were measured preoperatively by MRI. Differences in imaging parameters between the two groups were compared, and their correlation with catheter malposition was analyzed. Results TIVAP implantation success rate was 100% (165/165), with an intraoperative catheter tip malposition rate of 14.5% (24/165), all occurring in ipsilateral internal jugular vein. Malposition group exhibited significantly larger internal jugular vein diameters (12.31±1.60) mm and α angles (100.8±7.7)° compared to control group (10.91±1.63) mm and (91.67±4.12)°, with statistically significant differences (P<0.05). There was no significant difference in parameters A, C, or β angle between two groups (P>0.05). Conclusions During the implantation of TIVAP via right axillary vein, the increased diameter of internal jugular vein and the widened angle between subclavian and internal jugular veins constitute significant risk factors for catheter tip malposition. Preoperative MRI-based quantitative measurements of venous anatomy can provide predictive guidance for intraoperative catheter trajectory, facilitating the identification of high-risk individuals for catheter malposition and enabling personalized catheterization strategies to enhance procedural safety and positioning accuracy.

导出引用

陈浩, 陈露, 张寅. 经腋静脉完全植入式静脉输液港术中导管异位的影像学因素分析[J]. 中国临床解剖学杂志. 2025, 43(6): 640-644 https://doi.org/10.13418/j.issn.1001-165x.2025.6.03

Chen Hao, Chen Lu, Zhang Yin. Radiographic factor analysis of catheter malposition during totally implantable venous access port placement via the axillary vein[J]. Chinese Journal of Clinical Anatomy. 2025, 43(6): 640-644 https://doi.org/10.13418/j.issn.1001-165x.2025.6.03

中图分类号： R323.71 R322.123

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