探讨胸壁静脉输液港植入术中隧道针逆向穿刺的可行性和安全性。

选择2020年10月至2023年5月在无锡市惠山区中医医院需长期进行静脉输液或频繁进行静脉输液的患者16例。其中男性11例，女性5例；年龄50~77岁，平均（66.5 ± 6.8）岁，体质量55~82 kg，平均（65.8 ± 5.2）kg。在胸壁静脉输液港植入术中，隧道针经胸壁港体囊袋处沿皮下逆向穿刺至颈内静脉导管处，然后将导管连接隧道针并引导入胸壁港体囊袋中，确定导管头端位置后，修剪导管长度，连接固定港体。分析此操作的可行性和安全性，为临床应用提供依据。

16例胸壁静脉输液港均植入成功，彩色多普勒超声定位引导，利用三点一线法穿刺，颈内静脉一次穿刺成功率100%，隧道针逆向穿刺成功率100%，未发生血管和神经组织损伤，颈内静脉穿刺处均未进行切皮和缝合。

胸壁静脉输液港植入术中隧道针逆向穿刺引导导管，患者舒适度高、并发症发生率低、成功率高，安全可行，值得临床推广应用。

To explore the feasibility and safety of reverse puncture with tunnel needle during the implantation of totally implantable venous access ports to the chest wall.

A total of16 patients who needed long-term intravenous infusion or frequent intravenous infusion were selected,including 11 males and 5 females.The average age was (66.5 ± 6.8) years old (ranging from 50 to 77 years old). The average weight was (65.8 ± 5.2) kg (ranging from 55 to 82 kg). During port placement to the chest wall, the tunnel needle was punctured along the subcutaneous reverse direction through the chest wall port pocket to the internal jugular vein catheter. Then the catheter was connected to the tunnel needle and guided into the chest wall port pocket. After the position of the catheter tip was determined, the length of the catheter was trimmed, and the fixed port was connected. The feasibility and safety of this operation were analyzed to provide a basis for clinical application.

16 cases of port placement to the chest wall were successfully completed. Under the guidance of ultrasound positioning, the success rate of single puncture of internal jugular vein was 100%, and the success rate of reverse puncture of tunnel needle was 100%. There was no vascular and nerve tissue injury.

The tunnel needle reverse puncture guided catheter during ports placement to the chest wall is safe and feasible, with high comfort of patients, low incidence of complications and high success rate, which is worthy of clinical application.