经颈外静脉放置全植入式输液港在肿瘤化疗中的应用  

Implantation of Totally Implantable Venous Access Ports via External Jugular Vein in Chemotherapy for Cancer

作　　者：尹杰[1] 张宪生[1] 郭宏杰[1] 佘康 成功[1] 

机构地区：[1]北京大学第一医院介入血管外科,北京100034

出　　处：《中国微创外科杂志》2015年第3期210-214,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京大学第一医院院内青年学者启动基金项目

摘　　要：目的探讨经颈外静脉放置全植入式输液港（totally implantable venous access ports,TIVAP）作为肿瘤化疗静脉输液通路的可行性及术后并发症。方法对2010年1月-2013年12月96例行输液港植入术的肿瘤化疗患者进行回顾性研究,观察围手术期和远期并发症。结果全部病例均在术中完成输液港植入。经颈外静脉置管成功率95.8%（92/96）;2例因术前曾行放疗静脉挛缩,2例血管过细无法植入导管,改行同侧颈内静脉穿刺置管。术后中位随访26个月（8-46个月）,并发症发生率6.2%（6/96）。其中2例因肿瘤复发压迫造成输液港导管闭塞,1例导管移位,2例血栓形成,l例锁骨区皮肤疼痛。应用输液港装置化疗中输液顺畅,无渗漏,未发生气胸、血胸、导管相关性感染和夹闭综合征。结论经颈外静脉切开放置全植入式输液港是肿瘤化疗安全、快捷和有效的输液途径,可以避免气胸、血胸、夹闭综合征等严重并发症,主要并发症包括导管移位、阻塞、血栓形成。Objective To explore the feasibility and complications of totally implantable venous access ports（ TIVAP）implanted via external jugular vein in chemotherapy for cancers. Methods A retrospective review was conducted on 96 patients undergoing a TIVAP implantation for chemotherapy at this hospital from January 2010 to December 2013. Perioperational and long-term complications of the procedure were observed. Results The TIVAP was inserted in all the cases. The external jugular vein approach was successfully utilized in 92 cases（ 95. 8%）. In the remaining 4 cases（ 4. 2%）,the TIVAP placement was performed through ipsilateral internal jugular vein because of contractured vein due to preoperatively radiotherapy in the neck area in 2 cases and fine veins unable to implant the catheter in 2 cases. No immediate postoperative complications were detected. The patients were followed up for a median of 26 months（ 8- 46 months）. The overall complication rate was 6. 2%（ 6 /96）. There were 2 cases of catheter occlusion because of tumor recurrence,1 case of migration of the catheter,2 cases of thrombogenesis,and 1 case of clavicular skin pain. TIVAP worked well without leakage,pneumothorax,infection,or pinch-off syndrome. Conclusions External jugular vein approach appears to be a highly successful and safe alternative route and may be considered a potentially useful primary route for TIVAP placement in cancer patients. Main complications include catheter migration,occlusion,and thrombosis.

关 键 词：完全植入式静脉输液港 颈外静脉 化疗 

分 类 号：R730.53[医药卫生—肿瘤]