背景:完全可植入的静脉接入端口(TIVAP)是一种完全封闭的静脉输注系统,可在人体中长时间停留。它用于输注强刺激性或高渗药物,营养支持治疗,输血和血液标本采集,和其他目的。TIVAP有两种常见的方法:颈内静脉植入和锁骨下静脉植入。然而,两种植入方法的术后并发症有很大不同,相关指南中没有推荐的植入方法。因此,我们进行了一项荟萃分析,以评估两种植入方法的并发症差异,选择更好的植入方法。
方法:PubMed中的计算机搜索,Embase,WebofScience,和CochraneLibrary数据库进行从数据库建立到2021年10月的随机对照试验(RCT)。两名研究者根据纳入和排除标准独立筛选文献,提取的数据,并评估纳入研究的偏倚风险。采用RevMan5.4软件进行Meta分析。
结果:最终纳入5项研究共1086名患者。荟萃分析结果显示感染发生率无显著差异(RR=0.80,95%CI:0.43-1.48,p=0.47),导管堵塞(RR=0.72,95%CI:0.15-3.46,p=0.68),端口挤压(RR=1.07,95%CI:0.14-8.02,p=0.95),导管相关血栓形成(RR=0.86,95%CI:0.22-3.38,p=0.83),导管位移(RR=0.50,95%CI:0.22-1.12,p=.09),外渗(RR=0.12,95%CI:0.01-2.15,p=0.15),和导管破裂(RR=3.77,95%CI:0.16-89.76,p=.41)在两个植入路径之间。
结论:颈内静脉插入和锁骨下静脉插入的TIVAP并发症发生率差异不大。由于纳入研究的数量较少,有一定的局限性,未来需要纳入更多的研究进行分析。
BACKGROUND: Totally implantable venous access port (TIVAP) is a completely closed intravenous infusion system that stays in the human body for a long time. It is used for the infusion of strong irritating or hyperosmotic drugs, nutritional support treatment, blood transfusion and blood specimen collection, and other purposes. There are two common ways of TIVAP: internal jugular vein implantation and subclavian vein implantation. However, the postoperative complications of the two implantation methods are quite different, and there is no recommended implantation method in the relevant guidelines. Therefore, we conducted a meta-analysis to evaluate the difference in complications of the two implantation methods, and choose the better implantation method.
METHODS: Computer search in PubMed, Embase, Web of Science, and Cochrane Library database was conducted for randomized controlled trials (RCTs) from the establishment of the database to October 2021. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias in the included studies. RevMan5.4 software was used for meta-analysis.
RESULTS: A total of 1086 patients in five studies were finally included. The results of meta-analysis showed that there was no significant difference in the incidence of infection (RR = 0.80, 95% CI: 0.43-1.48, p = .47), catheter blockage (RR = 0.72, 95% CI: 0.15-3.46, p = .68), port squeeze (RR = 1.07, 95% CI: 0.14-8.02, p = .95), catheter-related thrombosis (RR = 0.86, 95% CI: 0.22-3.38, p = 0.83), catheter displacement (RR = 0.50, 95% CI: 0.22-1.12, p = .09), extravasation (RR = 0.12, 95% CI: 0.01-2.15, p = .15), and catheter rupture (RR = 3.77, 95% CI: 0.16-89.76, p = .41) between the two implantation paths.
CONCLUSIONS: There is little difference in the complication rate of TIVAP between internal jugular vein insertion and subclavian vein insertion. Due to the small number of included studies, there are certain limitations, and more studies need to be included for analysis in the future.