PDF(Pubmed)
Abstract：
BACKGROUND: A totally implanted venous access port (TIVAP) in the upper arm is a safe and cost-effective vascular access device and is widely used in breast cancer patients. Traditional tunnelling technique increases the operation time and has an unsatisfied cosmetic effect, so we explored the feasibility, cosmetic effect and complications of an upper arm port with a novel incision in this retrospective study.
METHODS: We reviewed 489 cases of totally implantable venous access port implantation in the upper arm with two types of incisions in our centre from 1 January 2018 to 30 January 2022. The patients were divided into two different incision groups including the puncture site incision group (n = 282) and the conventional tunnelling group (n = 207). The comparison of the results was collected between the two groups, and contributing factors were analyzed for major complications.
RESULTS: A total of 489 patients were successfully implanted with arm ports using the puncture site incision technique (n = 282, 57.7%) and conventional tunnelling technique (n = 207, 42.3%). The average operation time of the two types of incisions was 36.5 ± 15 min in the puncture site incision group and 55 ± 18.1 min in the tunnel needle group (P < 0.05). In terms of complications, 33 catheter-related complications occurred (6.4%), including 9 cases of infection, 15 cases of catheter-related thrombosis and 7 cases of skin exposure. Fourteen patients in the puncture site incision group developed complications compared with 17 in the traditional incision group. There were no significant differences between the two groups in terms of overall complication events (5.0% and 8.2%, P = 0.145) while the same result was found in each complication event. Weight, total cholesterol and diabetes were found to be associated with device-related infections in the univariate Cox proportional hazard regression models. Diabetes was found to be associated with device-related infections in multivariate analysis while hypertension was associated with thrombosis.
CONCLUSIONS: The puncture site incision method is a novel technique with a better cosmetic appearance and less operation time than the traditional tunnelling technique, providing a comparable overall rate of complications. It offers a preferable choice for clinicians when dealing with different situations of patients. It is worthy of being used and promoted for patients requiring the totally implanted venous access port in the upper arm.
METHODS: We reviewed 489 cases of totally implantable venous access port implantation in the upper arm with two types of incisions in our centre from 1 January 2018 to 30 January 2022. The patients were divided into two different incision groups including the puncture site incision group (n = 282) and the conventional tunnelling group (n = 207). The comparison of the results was collected between the two groups, and contributing factors were analyzed for major complications.
RESULTS: A total of 489 patients were successfully implanted with arm ports using the puncture site incision technique (n = 282, 57.7%) and conventional tunnelling technique (n = 207, 42.3%). The average operation time of the two types of incisions was 36.5 ± 15 min in the puncture site incision group and 55 ± 18.1 min in the tunnel needle group (P < 0.05). In terms of complications, 33 catheter-related complications occurred (6.4%), including 9 cases of infection, 15 cases of catheter-related thrombosis and 7 cases of skin exposure. Fourteen patients in the puncture site incision group developed complications compared with 17 in the traditional incision group. There were no significant differences between the two groups in terms of overall complication events (5.0% and 8.2%, P = 0.145) while the same result was found in each complication event. Weight, total cholesterol and diabetes were found to be associated with device-related infections in the univariate Cox proportional hazard regression models. Diabetes was found to be associated with device-related infections in multivariate analysis while hypertension was associated with thrombosis.
CONCLUSIONS: The puncture site incision method is a novel technique with a better cosmetic appearance and less operation time than the traditional tunnelling technique, providing a comparable overall rate of complications. It offers a preferable choice for clinicians when dealing with different situations of patients. It is worthy of being used and promoted for patients requiring the totally implanted venous access port in the upper arm.
摘要：
背景：上臂中的完全植入静脉接入端口（TIVAP）是一种安全且具有成本效益的血管接入装置，广泛用于乳腺癌患者。传统的隧道技术增加了操作时间，美容效果不理想，所以我们探索了可行性，在这项回顾性研究中，采用新型切口的上臂端口的美容效果和并发症。
方法：我们回顾了2018年1月1日至2022年1月30日在我们中心进行的489例上臂完全植入式静脉输液港两种切口植入的病例。将患者分为两个不同的切口组，包括穿刺部位切口组（n=282）和常规隧道组（n=207）。收集两组的结果比较,并对主要并发症的影响因素进行分析。
结果：共有489例患者使用穿刺点切口技术（n=282，57.7%）和传统隧道技术（n=207，42.3%）成功植入手臂端口。两种切口的平均手术时间穿刺部位切口组36.5±15min,隧道针组55±18.1min(P<0.05)。在并发症方面,发生导管相关并发症33例（6.4%），包括9例感染，导管相关性血栓15例,皮肤暴露7例。与传统切口组的17例相比，穿刺部位切口组的14例患者发生了并发症。两组在总体并发症事件方面无显著差异(5.0%和8.2%,P=0.145），而在每个并发症事件中都发现了相同的结果。重量,在单变量Cox比例风险回归模型中,发现总胆固醇和糖尿病与器械相关感染相关.在多变量分析中发现糖尿病与设备相关感染相关，而高血压与血栓形成相关。
结论：与传统的隧道技术相比，穿刺点切口方法是一种新颖的技术，具有更好的外观和更少的手术时间，提供了相当的并发症的总发生率。在处理不同的患者情况时，它为临床医生提供了首选。对于需要上臂完全植入静脉接入端口的患者，值得使用和推广。
方法：我们回顾了2018年1月1日至2022年1月30日在我们中心进行的489例上臂完全植入式静脉输液港两种切口植入的病例。将患者分为两个不同的切口组，包括穿刺部位切口组（n=282）和常规隧道组（n=207）。收集两组的结果比较,并对主要并发症的影响因素进行分析。
结果：共有489例患者使用穿刺点切口技术（n=282，57.7%）和传统隧道技术（n=207，42.3%）成功植入手臂端口。两种切口的平均手术时间穿刺部位切口组36.5±15min,隧道针组55±18.1min(P<0.05)。在并发症方面,发生导管相关并发症33例（6.4%），包括9例感染，导管相关性血栓15例,皮肤暴露7例。与传统切口组的17例相比，穿刺部位切口组的14例患者发生了并发症。两组在总体并发症事件方面无显著差异(5.0%和8.2%,P=0.145），而在每个并发症事件中都发现了相同的结果。重量,在单变量Cox比例风险回归模型中,发现总胆固醇和糖尿病与器械相关感染相关.在多变量分析中发现糖尿病与设备相关感染相关，而高血压与血栓形成相关。
结论：与传统的隧道技术相比，穿刺点切口方法是一种新颖的技术，具有更好的外观和更少的手术时间，提供了相当的并发症的总发生率。在处理不同的患者情况时，它为临床医生提供了首选。对于需要上臂完全植入静脉接入端口的患者，值得使用和推广。
