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題 名 | Clinical Experience with Ventricular Endomyocardial Biopsy in Chinese Heart Transplant Patients: A Four-Year Survey of 1,208 Consecutive Procedures=中國人心臟移植患者心室肌內膜活體切片手術之臨床經驗:在四年內共計1,208人次回溯性探討 |
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作 者 | 黃建銘; 楊茂勳; 汪以進; 張忠毅; 魏崢; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 14:3 民87.07-09 |
頁 次 | 頁105-110 |
分類號 | 416.262 |
關鍵詞 | 中國人; 心室肌肉膜活體切片; 併發症; 心臟移植; Chinese; Endomyocardial biopsy; Complications; Heart transplant; |
語 文 | 英文(English) |
中文摘要 | 背景:一般認為心臟移植患者評估其術後是否發生排斥之最單純且有效的步驟,是以經右頸靜脈進行右心室肌內膜活體切片的方式。雖然,絕大多數的學者認為這種檢查步驟是很安全的,但是在文獻上,卻鮮有學者提出這類的大型研究,並探討其手術併發症的問題。本研究的目的主要是將本院在過去四年來在中國人之心臟移植患者進行切片時所發生的併發症做回溯性報告,同時也回顧歷史文獻,以了解併發症的種類與預防之道。 方法與結果:本研究在中國人心臟移植患者進行總計1,208人次切片之併發症回顧。其中,有99.7%的患者是採用經頸靜脈的方式,其次,有0.3%的患者是採用經股動脈的方式。併發症發生率低於1.2%,無右心穿孔,心包填塞或者死亡,而其中最常見之併發症為頸動脈刺穿,發生右心腱索斷裂以及胸痛之併發症者各有一案例,術後追蹤顯示兩例皆無後遺症。在文獻所記載之併發症中,如出血不止,嚴重心律不整,心臟節律器導線脫落以及迷走神經反應,皆未發生在本研究對象。 結論:不論是經由右心或者左心進行活體切片,其成功率與安全性主要取決於手術者本身的經驗,雖然,做心臟活體切片時所承受的風險並不高,但面對著越來越多的心臟移植存活者,長期切片後在心室肌所遺留下來的疤痕,將使心臟切片手術的困難度提升,除此之外,在移植後心臟位置不正者也應納入技術性的考量。當然,我們也期待將來有更新更安全有效的技術來篩檢心臟移植排斥的問題。 |
英文摘要 | Background. Right ventricular endomyocardial biopsy (EMB), obtained with a bioptome inserted via the right internal jugular vein, remains the single most useful aid in assessing rejection in the donor heart. Although EMB is usually considered a safe procedure, large studies of the complications caused by EMB, especially in the transplant population, are rare. It is our intention to demonstrate our experience with complications of EMB in Chinese cardiac transplant patients. We also review several important techniques from our experience and worldwide series in prevention of unwanted sequalae during EMB. Methods and Results. We have reviewed the complications in 1,208 consecutive EMBs of donor hearts in a Chinese population. Right ventricular biopsy was performed in 99.7% of procedures via the right internal jugular vein approach with a Scholten bioptome using fluoroscopic guidance. The other 0.3% of biopsies were performed from the right femoral artery using a disposable system. The complication rate was 1.2%, without perforation or mortality. The most common complication was carotid artery puncture. One patient had chordae tendineae rupture and one patient had chest pain, without sequalae. There were no other complications such as vasovagal reaction, prolonged bleeding, pacemaker dislodgment, or serious cardiac arrhythmias. Conclusions. Based on the results of worldwide series, the safety and success of techniques for right and left heart biopsy depends on the performing doctor's experience. Although the overall rate of EMB complications is low in transplant patients, it is important to develop a safer and more accurate diagnostic technique in the near future for monitoring cardiac allograft rejection. |
本系統中英文摘要資訊取自各篇刊載內容。