DSA引导下改良股静脉植入输液港术式在恶性肿瘤患者中的应用  

Application of DSA-guided modified implantation technique of infusion port via femoral vein in treating patients with malignant tumors

作　　者：郝伟远 陈玉堂 林婧 郑家平 邵国良[1] HAO Weiyuan;CHEN Yutang;LIN Jing;ZHENG Jiaping;SHAO Guoliang(Institute of Cancer and Basic Medicine,Chinese Academy of Sciences,Affiliated Cancer Hospital of the University of Chinese Academy of Sciences,Department of Interventional Therapy of Zhejiang Provincial Cancer Hospital,Hangzhou,Zhejiang Province 310022,China)

机构地区：[1]中国科学院肿瘤与基础医学研究所/中国科学院大学附属肿瘤医院/浙江省肿瘤医院介入治疗科,杭州310022

出　　处：《介入放射学杂志》2021年第8期780-783,共4页Journal of Interventional Radiology

摘　　要：目的探讨DSA引导下经股静脉植入输液港改良术式在恶性肿瘤患者中的应用的安全性、技术可行性及相关并发症。方法选择2014年2月至2020年1月26例接受DSA引导下改良股静脉植入输液港术式的恶性肿瘤患者,采用Seldinger技术穿刺右侧股静脉,于右下腹壁植入静脉输液港。所有患者进行随访,随访终点为输液港移除或患者死亡。结果26例患者植入均获成功,术中无并发症发生,平均手术时间(22.1±6.9)min。10例术中出现导管异位至对侧髂静脉或腰静脉,在DSA下调整后均成功进入下腔静脉主干,导管头端位于下腔静脉位置:10例位于腰2椎体水平,11例位于腰3椎体水平,5例位于腰4椎体水平。随访780个导管日,共发生4例并发症,其中1例为纤维蛋白鞘形成,1例为囊袋感染破溃,1例为导管卷曲异位至皮下,1例为导管于腹股沟处打折致输液不畅,其中3例致非计划拔管。26例患者均未发生深静脉血栓形成、相关肢体运动受限及不适感等并发症。无相关死亡事件发生。结论对于无法植入胸壁输液港的患者,在DSA引导下行改良经股静脉植入输液港术式是安全可行的,并发症发生率低。Objective To investigate the safety, technical feasibility and related complications of DSA-guided modified implantation technique of totally implantable access port(TIAP) via femoral vein in treating patients with malignant tumors. Methods A total of 26 patients with malignant tumors, who received DSAguided modified implantation of TIAP via femoral vein between February 2014 and January 2020 at authors’ hospital, were enrolled in this study. By using Seldinger technique, the right femoral vein was punctured,which was followed by the implantation of TIAP in the right lower abdominal wall. All patients were followed up till the TIAP was removed or the patient died. Results Successful TIAP implantation was accomplished in all the 26 patients. The mean time spent for the procedure was(22.1±6.9) min. In 10 patients the catheter immigrated into the contralateral iliac vein or lumbar vein, after adjusting its position the catheter successfully entered the inferior vena cava trunk. The catheter tip was placed at lumbar 2 vertebral body level(n=10),lumbar 3 vertebral body level(n=11) or lumbar 4 vertebral body level(n=5). The patients were followed up for780 catheter-days. Complications occurred in 4 patients, including formation of fibrin sheath(n=1), skin infection and ulceration at port site with barely exposed port base(n=1), catheter curling and shifting into subcutaneous site(n=1), and catheter folding at groin region causing blocked infusion(n=1). Among the 4 patients, unplanned retrieval of catheter had to be carried out in 3 patients. No deep venous thrombosis, limb movement limitation or discomfort feeling were observed in all the 26 patients. No procedure-related death occurred. Conclusion For patients who have contraindications to implant TIAP in the chest wall, DSA-guided modified implantation of TIAP in the right lower abdominal wall via femoral vein is safe and feasible, besides, this technique carries lower incidence of complications.(J Intervent Radiol, 2021, 30: 780-783)

关 键 词：股静脉 输液港 恶性肿瘤 

分 类 号：R73.3[医药卫生—肿瘤] R472[医药卫生—临床医学]