完全植入式输液港在肿瘤化疗患者中的应用  

Application of totally implantable venous access devices in patients with chemotherapy

作　　者：彭建军[1] 彭利芬[1] 陈斯乐[1] 徐建波[1] 何裕隆[1] 

机构地区：[1]中山大学附属第一医院胃肠胰外科,中山大学胃癌诊治研究中心,广州510080

出　　处：《消化肿瘤杂志（电子版）》2013年第1期56-60,共5页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的结合临床应用阐述完全植入式输液港使用技巧及相关并发症的处理。方法回顾分析过去3年接受完全植入式输液港放置的389例肿瘤化疗患者临床手术及应用随访资料,分析该设备留置过程相关并发症。结果 389例患者全部穿刺置管成功,其中经右锁骨下静脉穿刺置管者162例,经颈内静脉穿刺置管者227例。手术过程中最常见的并发症是误穿刺动脉(锁骨下静脉组:3/162,1.9%;颈内静脉组:5/227,2.2%);应用随访过程中最常见的非感染性并发症是深静脉血栓(锁骨下静脉组:7/162,4.3%;颈内静脉组:5/227,2.2%)和导管堵塞(锁骨下静脉组:4/162,2.5%;颈内静脉组:3/227,1.3%),感染性并发症主要是菌血症或败血症(锁骨下静脉组:5/162,3.1%;颈内静脉组:4/227,1.8%)和输液港位置感染(锁骨下静脉组:1/162,0.6%;颈内静脉组:4/227,1.8%),1.2%(2/162)经锁骨下静脉穿刺置管患者出现夹闭综合征(pinch-off syndrome)。结论完全植入式输液港对于肿瘤化疗患者是一种安全可靠的用药通道,手术植入和临床应用过程中伴随的并发症需要更加细心的临床维护工作,为患者谋求最大的获益。Objective To investigate the exprecience of port catheter implantation and the complications of totally implantable venous access devices(TIVADs) during the procedure and chemotherapy. Methods Three hundred and eighty-nine patients received implantation of totally implantable venous access ports and chemotherapy in our department from September 2009 to September2011. Early and late complications and their management were analyzed. Results Among the patients with catheters implanted, port catheter was implanted by internal carotid vein(ICV) and subclavian vein(SCV) respectively in 227 and 162 patients. Eight patients including 3(1.9%) in SCV group and 5(2.2%) in ICV group had artery injury during the operation. Complications occurred in 19(11.7%,0.073 / 1000 catheter days) patients in SCV group and 18(7.9%, 0.068 / 1000 catheter days) patients in ICV group after port implantation. The common complications during follow-up included deep vein thrombosis(7 in SCV, 4.3%, 0.027 / 1000 catheter days; 5 in ICV, 2.2%, 0.019 / 1000 catheter days), bacteremia or local port infection(6 in SCV, 3.7%, 0.023 / 1000 catheter days; 8 in ICV,3.6%, 0.030 / 1000 catheter days) and obstruction of catheter(4 in SCV, 2.5%, 0.015 / 1000 catheter days; 3 in ICV, 1.3%, 0.011 / 1000 catheter days). Only 2 patients(1.2%, 0.008 / 1000 catheter days) in SCV group were found with pinch-off syndrome. Conclusion TIVADs provide safe and reliable vascular access for patients with chemotherapy. A dedicated team of trained medical professionals is required to minimize its complications and extend its usage life while administering treatment.

关 键 词：完全植入式输液港 恶性肿瘤 化疗 夹闭综合征 

分 类 号：R730.56[医药卫生—肿瘤]