外周穿刺中心静脉导管与完全植入式静脉输液港在儿童肿瘤的临床比较  

Peripherally-inserted central venous catheter vs totally-implantable venous access port in treating pediatric tumors: comparison of clinical efficacy

作　　者：李晨晨 胡明[1] 褚珺[1] 陈其民[1] 蔡金晶 LI Chenchen;HU Ming;CHU Jun;CHEN Qimin;CAI Jinjing(Department of Pediatric Surgery,Affiliated Shanghai Children＇s Medical Center,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心小儿外科,200127

出　　处：《介入放射学杂志》2018年第8期735-739,共5页Journal of Interventional Radiology

摘　　要：目的探讨肿瘤患儿最为安全、有效的长期中心静脉导管留置方式。方法回顾性研究2006年1月至2017年12月共1 047例长期中心静脉导管留置的肿瘤患儿,其中经外周穿刺中心静脉导管(PICC)436例,完全植入式静脉输液港(TIVAP)611例。比较两组患儿的近、远期并发症,并作统计学分析。结果 PICC组并发症发生率21.2%(98/463):近期并发症32例(导管末端位置异常10例,穿刺处机械性静脉炎17例,局部皮下血肿5例);远期并发症66例(导管阻塞及血栓形成25例、导管相关性感染20例,导管移位滑脱16例,导管渗漏断裂5例)。TIVAP组并发症发生率5.6%(34/611):近期并发症13例(血肿3例,误穿动脉9例,夹闭综合征1例);远期并发症21例(导管阻塞及血栓形成3例、导管相关性感染13例,导管或泵体破裂渗漏3例,导管与血管壁粘连取出困难2例)。TIVAP组并发症发生率明显低于PICC组(P<0.05)。结论 TIVAP具有并发症少,安全耐用的优势。PICC则置入简便、无需麻醉,费用低,置入后能即刻使用的特点。两者均能显著减少患儿的疼痛并提高生活质量。故对于儿童肿瘤患儿,应根据个体化差异灵活选择合适的中心静脉导管留置方式。Objective To discuss the most safe and effective long-term retention mode of central venous catheter in children with cancer. Methods A total of 1 047 pediatric patients with cancer, who received long-term retention of central venous catheter during the period from January 2006 to December2017, were retrospectively analyzed. Of the 1 047 pediatric patients, 436 patients received peripherallyinserted central venous catheter（PICC） and 611 patients received totally-implantable venous access port（TIVAP）. The early and late complications were recorded and the results were statistically compared between the two groups. Results In PICC group, the incidence of complications was 21.2%（98/463）, including early complications（n=32） and late complications（n=66）. The early complications included abnormal position of catheter tip（n=10）, mechanical phlebitis of catheter insertion site（n=17） and local subcutaneous hematoma（n =5）; the late complications included catheter obstruction and thrombosis（n =25）, catheter-related infection（n=20）, catheter shifting and slipping（n=16）, and catheter leakage and fracture（n=5）. In TIVAP group, the incidence of complications was 5.6%（34/611）, including early complications（n =13） and late complications（n=21）. The early complications included hematoma（n=3）, miss-insertion into artery（n=9）and pinch-off syndrome（n=1）; the late complications included catheter obstruction and thrombosis（n=13）,catheter-related infection（n=13）, rupture and leakage of catheter or pump body（n=3）, and catheter retrieval difficulty due to adhesion of catheter with vascular wall（n=2）. The incidence of complications in TIVAP group was significantly lower than that in PICC group（P〈0.05）. Conclusion TIVAP has the advantages of less complications, safety and durability, while PICC has the merits of easy insertion, unnecessary of anesthetization, low cost, and capable of being used immediately after being placed. Both of the two techniq

关 键 词：儿童 肿瘤 中心静脉置管术 经外周穿刺中心静脉导管 完全植入式静脉输液港 并发症 

分 类 号：R284[医药卫生—中药学]