The clinical data of 23 patients undergoing real-time echocardiography-guided infusion port implantation in the Breast Center of Tsinghua Changgung Hospital in Beijing from January to July 2021 were analyzed. The length of catheter insertion L1 was initially estimated using surface measurement method in all patients. Intraoperatively, transthoracic echocardiography was applied using the parasternal four-chamber view to visualize the catheter image within the right atrium, and the length of catheter insertion L2 was recorded under the guidance of echocardiography. Postoperatively, chest radiographs were taken in the upright position to observe the position of the catheter tip. According to chest CT scans, the ideal length (L) for catheter tip placement was calculated when it was located at the junction of superior vena cava and right atrium. Bland-Altman scatter plot analysis and linear regression fitting test were used on L1 and L2 respectively with L to evaluate the consistency. A total of 23 patients were included in this study, among which one case of left breast cancer patient undergoing breast-conserving surgery had difficulty in identifying the catheter tip position due to residual pleural effusion obscuring the imaging of the cardiac apex four-chamber view. In 22 patients, the results of intraoperative ultrasound imaging were good, including 1 case of catheter ectopic to azygos vein, and 21 cases of right atrial catheter could be detected by ultrasound. Statistical analysis showed that there was a good consistency between L1 and L, L2 and L, and the difference between them was d=0.28 cm (95%CI:-1.76-2.31 cm) and d=0.20 cm(95%CI:-0.84-1.23 cm), respectively, with no statistical significance (P>0.05). In the linear regression model, L2 and L had a higher fit than L1, and the difference was statistically significant (R²=0.954, P<0.001). This study found that real-time echocardiographic localization technique can be applied in adult port surgery to replace X-ray-guided real-time catheter tip detection and adjustment to the optimal position.
分析2021年1至7月北京清华长庚医院乳腺中心进行实时超声心动图引导下输液港植入手术的23例患者的临床资料。所有患者先采用体表测量法预估导管置入长度L1，术中应用经胸壁超声心动图技术通过心尖四腔心切面在右心房内探测导管影像，记录超声心动图法指导下导管置入长度L2。术后拍摄胸部X线正位片观察导管尖端位置，结合患者胸部CT计算导管尖端位于上腔静脉和右心房连接处时应置入理想长度L。将L1和L2分别与L进行Bland-Altman散点图一致性分析和线性回归拟合度检验，分析其一致性。研究共纳入23例患者，其中1例左侧乳腺癌患者保乳手术区域靠近心尖部，因残腔浆液肿，影响心尖部四腔心切面的成像效果，难以识别导管尖端位置。22例患者术中超声成像效果良好，其中1例导管异位至奇静脉，另外21例可经超声探测到右心房内导管。统计学分析显示，L1与L、L2与L的一致性较好，两者差值分别为d=0.28 cm（95%CI：-1.76~2.31 cm）、d=0.20 cm（95%CI：-0.84~1.23 cm），差异无统计学意义（P>0.05）。线性回归模型下，与L1相比L2与L的拟合度更高，差异有统计学意义（R²=0.954，P<0.001）。研究发现超声心动图实时定位技术可应用于成人输液港手术，替代术中X线辅助下实时探查导管尖端并调整至最佳位置。.