目的:完全植入式静脉输液港(TIVAP)为患者提供安全,有效和长期方便的静脉通路,用于管理药物,如化疗药物。TIVAP的植入和长期使用与血栓形成有关,感染和其他并发症。在这项研究中,收集了多中心患者的医疗记录,对围手术期及术后并发症进行回顾性分析,客观评价锁骨上植入术的安全性,超声引导TIVAP通过头臂静脉(BCV)。
方法:我们回顾性分析了2018年3月至2019年5月在中国四家医院接受超声引导下通过BCV植入TIVAP的433例成年患者的临床资料。第一次穿刺的成功率,操作时间,分析围手术期及术后并发症。
结果:所有TIVAP均成功植入(100%)。TIVAP携带时间平均为318.15±44.22天(范围:38-502天),总共为197,694天。首次穿刺成功率为94.92%(411/433),手术时间18~60min,平均29.66±7.45min。围手术期并发症包括动脉穿刺4例,气胸1例。术后并发症发生率为5.08%(22/433),包括切口愈合不良(n=2),导管相关性感染(n=3),口岸感染(n=6),血栓形成(n=2)和纤维蛋白鞘形成(n=8)。另一名患者在手术后2天出现输液障碍,胸部X线片显示导管和端口之间的连接处弯曲。无其他严重并发症发生,如导管破裂和药物泄漏。并发症总发生率为6.24%(27/433)。
结论:这项研究显示了对锁骨上,超声引导下BCV穿刺植入TIVAP,并发症发生率低。作为一种安全有效的TIVAP植入方法,为临床医生提供了新的选择。
OBJECTIVE: The totally implantable venous access port (TIVAP) provides patients with safe, effective and long-term convenient venous access for the administration of medications such as chemotherapy drugs. The implantation and long-term use of TIVAP are related to thrombosis, infection and other complications. In this study, the medical records of multicentre patients were collected, and the perioperative and postoperative complications were retrospectively analysed to objectively evaluate the safety of the implantation of supraclavicular, ultrasound-guided TIVAP via the brachiocephalic vein (BCV).
METHODS: We retrospectively analysed the clinical data of 433 adult patients who had undergone ultrasound-guided TIVAP implantation via the BCV at four hospitals in China from March 2018 to May 2019. The success rates of the first puncture, operation time, and perioperative and postoperative complications were analysed.
RESULTS: All the TIVAPs were implanted successfully (100%). The average TIVAP carrying time was 318.15 ±44.22 days (range: 38-502 days) for a total of 197,694 catheter days. The success rate of the first puncture was 94.92% (411/433), and the average operation time was 29.66 ±7.45 min (range: 18-60 min). The perioperative complications included arterial puncture in 4 patients and pneumothorax in 1 patient. The incidence of postoperative complications was 5.08% (22/433), including poor incision healing (n = 2), catheter-related infection (n = 3), port infection (n = 6), thrombosis (n = 2) and fibrin sheath formation (n = 8). Another patient had infusion disturbance 2 days after the operation, and chest X-ray showed bending at the connection between the catheter and port. No other serious complications occurred, such as catheter rupture and drug leakage. The total incidence of complications was 6.24% (27/433).
CONCLUSIONS: This study showed excellent tolerance of supraclavicular, ultrasound-guided BCV puncture to implant TIVAP and a low incidence of complications. As a safe and effective method of TIVAP implantation, it can provide a new choice for clinicians.