目的:评价股静脉、锁骨下静脉、颈内静脉全植入术治疗恶性肿瘤的安全性及并发症临床应用。方法:选择2016年9月至2020年12月接受植入式静脉输液港的286例患者开展回顾性分析,全植入式静脉通路端口286个,其中股静脉43个、颈内静脉100个、锁骨下静脉143个,分析患者术后3组不同植入路径发生并发症的影响因素。结果:286例全植入术静脉通道中发生并发症77例(26.9%),其中导管阻塞16例,血流感染14例,皮肤破裂7例,中央静脉血栓形成6例,导管移位3例,回抽无回血6例。286个完全可植入式静脉通路中未发现年龄、性别、输液港位置、肿瘤类型、导管类型与并发症有相关性(P > 0.05)。股静脉组术后血栓症发生率高于锁骨下静脉和颈内静脉组(P < 0.05)。股静脉回抽无回血发生率高于锁骨下静脉组术后(P < 0.05)。在非计划取港率和其他并发症上差异无统计学意义(P > 0.05)。结论:经股静脉、锁骨下静脉或颈内静脉全植入式静脉通道移植在恶性肿瘤患者中是安全可行的,且通道相关并发症发生率低。 Objective: To evaluate the safety and complications of totally implantable venous access port implantation via femoral vein, subclavian vein or internal jugular vein in patients with malignancy. Method: A total of 286 totally implantable venous access ports were placed in 286 patients with malignancy between Sep 2016 and Dec 2020 (43 via femoral vein, 100 via jugular vein and 143 via subclavian vein). The influencing factors of postoperative complications in 3 groups of patients with different implantation paths were analyzed. Result: Among the 286 cases of total implantation, 77 cases (26.9%) had complications, including catheter obstruction in 16 cases, bloodstream infection in 14 cases, skin rupture in 7 cases, central venous thrombosis in 6 cases, catheter displacement in 3 cases, and no blood return in 6 cases. There was no correlation between age, gender, infusion port location, tumor type, catheter type and complications in 286 fully implantable venous pathways (P > 0.05). The incidence of postoperative thrombosis in the femoral vein group was higher than that in the subclavian vein group and the internal jugular vein group (P < 0.05). The incidence of no blood return in the femoral vein was higher than that in the subclavian vein group (P < 0.05). There was no significant difference in unplanned port taking rate and other complications (P > 0.05). Conclusion: These data indicate that totally implantable venous access port implantation via the femoral vein, subclavian vein or internal jugular vein in patients with malignancy is safe and feasible, with a low access-related complication rate.
目的:评价股静脉、锁骨下静脉、颈内静脉全植入术治疗恶性肿瘤的安全性及并发症临床应用。方法:选择2016年9月至2020年12月接受植入式静脉输液港的286例患者开展回顾性分析,全植入式静脉通路端口286个,其中股静脉43个、颈内静脉100个、锁骨下静脉143个,分析患者术后3组不同植入路径发生并发症的影响因素。结果:286例全植入术静脉通道中发生并发症77例(26.9%),其中导管阻塞16例,血流感染14例,皮肤破裂7例,中央静脉血栓形成6例,导管移位3例,回抽无回血6例。286个完全可植入式静脉通路中未发现年龄、性别、输液港位置、肿瘤类型、导管类型与并发症有相关性(P > 0.05)。股静脉组术后血栓症发生率高于锁骨下静脉和颈内静脉组(P < 0.05)。股静脉回抽无回血发生率高于锁骨下静脉组术后(P < 0.05)。在非计划取港率和其他并发症上差异无统计学意义(P > 0.05)。结论:经股静脉、锁骨下静脉或颈内静脉全植入式静脉通道移植在恶性肿瘤患者中是安全可行的,且通道相关并发症发生率低。
股静脉,锁骨下静脉,颈内静脉,输液港,并发症
Lei Li1, Hui Zhang2, Jianjun Zou1, Yalin Xie1, Ning Su1, Shan Su1, Wenchang Cen1
1Department of Oncology, Guangzhou Chest Hospital, Guangzhou Guangdong
2Department of Radiology, Guangzhou Chest Hospital, Guangzhou Guangdong
Received: Dec. 13th, 2021; accepted: Jan. 3rd, 2022; published: Jan. 18th, 2022
Objective: To evaluate the safety and complications of totally implantable venous access port implantation via femoral vein, subclavian vein or internal jugular vein in patients with malignancy. Method: A total of 286 totally implantable venous access ports were placed in 286 patients with malignancy between Sep 2016 and Dec 2020 (43 via femoral vein, 100 via jugular vein and 143 via subclavian vein). The influencing factors of postoperative complications in 3 groups of patients with different implantation paths were analyzed. Result: Among the 286 cases of total implantation, 77 cases (26.9%) had complications, including catheter obstruction in 16 cases, bloodstream infection in 14 cases, skin rupture in 7 cases, central venous thrombosis in 6 cases, catheter displacement in 3 cases, and no blood return in 6 cases. There was no correlation between age, gender, infusion port location, tumor type, catheter type and complications in 286 fully implantable venous pathways (P > 0.05). The incidence of postoperative thrombosis in the femoral vein group was higher than that in the subclavian vein group and the internal jugular vein group (P < 0.05). The incidence of no blood return in the femoral vein was higher than that in the subclavian vein group (P < 0.05). There was no significant difference in unplanned port taking rate and other complications (P > 0.05). Conclusion: These data indicate that totally implantable venous access port implantation via the femoral vein, subclavian vein or internal jugular vein in patients with malignancy is safe and feasible, with a low access-related complication rate.
Keywords:Femoral Vein, Subclavian Vein, Jugular Vein, Implantable Venous Access Port, Complication
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
全植入式静脉通路(Totally implantable venous access ports, TIVAPs)是一种有效的长期化疗方法,该项技术由Niederhuber首次报道,是一种安全方便的穿刺方式 [
我们回顾性收集患者的病历资料,从2016年9月至2020年12月接受植入式静脉输液港的286例患者,植入了286个完全可植入式静脉通路端口,其中43例股静脉,143例通过锁骨下静脉,100例颈内静脉。记录患者情况见表1。所有患者均为恶性肿瘤,其中肺癌196例,结肠直肠癌15例,鼻咽癌11例等多种恶性肿瘤病例,并计划接受并静脉化疗。这些患者包括222名男性和64名女性,平均年龄62.89 ± 10.54岁(范围:26~95岁),平均身高体重指数BMI 20.37 ± 3.35 kg/m2 (范围:12.86~31.45 kg/m2)。所有的病例均在我院行手术治疗,大部分为恶性肿瘤,并需行静脉化疗。其中肿瘤患者主要来自于肿瘤科。所有病例均从植入输液港时开始随访,直至取港或死亡结束。因港体外露、感染等并发症,在未完成治疗的情况下取港为未非计划取港,其中个别病例因非计划取港,其随访时间较短。本研究已获本机构审查委员会批准,术前均获取所有患者书面知情许可。
病人特征 | 病例[n(%)] |
---|---|
年龄 | |
≥50 | 259 (90.56) |
<50 | 27 (9.44) |
性别 | |
男 | 222 (77.62) |
女 | 64 (22.38) |
肿瘤类型 | |
肺癌 | 196 (68.53) |
结肠直肠癌 | 15 (5.24) |
鼻咽癌 | 11 (3.85) |
淋巴瘤 | 11 (3.85) |
食管癌 | 12 (4.2) |
乳腺癌 | 8 (2.8) |
肝癌 | 7 (2.45) |
口咽癌 | 2 (0.7) |
胃癌 | 5 (1.75) |
恶性腹膜间皮瘤 | 3 (1.05) |
其他 | 16 (5.59) |
输液港位置 | |
锁骨下静脉 | 143 (50) |
股静脉 | 43 (15.03) |
颈内静脉 | 100 (34.97) |
表1. 患者一般资料
采用完全植入式耐高压静脉输液港TIVAP (美国,斯密斯公司)。用75%乙醇或10%聚维定碘溶液在静脉插管前涂抹于皮肤表面(干燥/至少停留2分钟),导管尖端位于上腔静脉,注射口置于胸壁的皮下,并与硅酮导管相连。采用Seldinger锁骨静脉改良穿刺技术 [
对于可能造成并发症的多种因素(如年龄、性别、输液港位置、肿瘤类型,导管类型等)的相关性进行分析,比较术后出现各类并发症的情况。
采用GraphPad Prism 9.1.2软件进行统计学分析处理。计量资料以例数以[n(%)]进行统计描述,组间比较采用X2检验,P < 0.05表示有显著差异性。
本研究病患共有286例全植入静脉通道中发生并发症77例(26.9%),股静脉通路43例发生并发症17例(39.53%),锁骨下静脉143例发生并发症36例(25.17%),颈内静脉100例发生并发症24例(24%)。其中导管阻塞16例,血流感染14例,皮肤破裂7例,中央静脉血栓形成6例,导管移位3例,回抽无回血6例。对年龄、性别、输液港位置、肿瘤类型、导管类型等因素与并发症的相关性进行分析见表2,结果表明与并发症的无相关性(P > 0.05),由此可知,上述因素并未造成并发症的危险因素。
病人特征 | 病例(n) | 并发症 | X2 | P | |
---|---|---|---|---|---|
有 | 无 | ||||
年龄 | 0.015 | 0.902 | |||
≥50 | 259 | 70 | 189 | ||
<50 | 27 | 7 | 20 | ||
性别 | 1.454 | 0.228 | |||
男 | 222 | 56 | 166 | ||
女 | 64 | 21 | 43 | ||
肿瘤类型 | 1.475 | 0.225 | |||
肺癌 | 196 | 57 | 139 | ||
其他 | 90 | 20 | 70 | ||
导管类型 | 0.015 | 0.902 | |||
PORT-A-CATH II | 87 | 23 | 64 | ||
PORT-A-CATH II POWER P.A.C. | 199 | 54 | 145 | ||
输液港位置 | 2.113 | 0.146 | |||
锁骨下静脉 | 143 | 36 | 107 | ||
颈内静脉 | 100 | 24 | 76 | ||
股静脉 | 43 | 17 | 26 |
表2. 患者并发症的相关因素
所有患者均完成输液港植入术,各类并发症及非计划取港情况见表3。术后并发症发生率比较,股静脉组术后血栓症发生率为6.98%,高于锁骨下静脉和颈内静脉组,其血栓症发生率分别为0.7%和2% (P < 0.05)。股静脉回抽无回血发生率6.98%高于锁骨下静脉发生率2.1% (P < 0.05)。对于其他并发症和非计划取港之间比较无差异(P > 0.05)。
并发症 | 股静脉(N = 43) | 锁骨下静脉(N = 143) | 颈内静脉(N = 100) | P |
---|---|---|---|---|
导管阻塞 | 5 (11.63) | 6 (4.2) | 5 (5) | 0.169 |
感染 | 3 (6.98) | 3 (2.1) | 8 (8) | 0.372 |
皮肤破裂 | 0 | 3 (2.1) | 4 (4) | 0.339 |
血栓症 | 3 (6.98) | 1 (0.7) | 2 (2) | 0.042* |
导管移位 | 0 | 1 (0.7) | 2 (2) | 0.473 |
回抽无回血 | 3 (6.98) | 3 (2.1) | 0 | 0.028* |
非计划取港 | 3 (6.98) | 5 (3.5) | 10 (10) | 0.119 |
表3. 不同路径放置完全植入式静脉输液港并发症情况
注:*P < 0.05差异具有统计学意义。
恶性肿瘤是人类疾病最大问题,主要由不同方式侵入对人体健康带来严重危害,因此需要长期应用化学治疗。而TIVAP作为一种可长期使用的静脉输液通路,以输注化疗药物和抗生素进行静脉穿刺,提高了患者对化疗的依赖 [
综上所述,本研究进行不同途径植入TIVAP后并发症发生率的比较研究,发现股静脉和锁骨下静脉发生并发症发生率趋势更高,尤其是血栓症及回抽无回血的发生率偏高,则可以优选另一种方式。其他并发症和非计划取港发生率3种方式不存在明显差异。考虑到造成非计划取港的原因较多,且也并非所有的血栓症及回抽无回血发生时都需立即取港,还需进一步研究。总之,颈内静脉和锁骨下静脉以及股静脉路径植入法均安全有效,减轻了反复静脉穿刺的痛苦。本研究为回顾性研究,存在一定的局限性,在静脉血栓和感染等并发症上可能统计不全面以及其他未知因素有待进一步验证。
广州市卫生和计划生育科技项目,编号:806070664044。
李 磊,张 晖,邹建军,谢亚琳,苏 宁,苏 珊,岑文昌. 不同路径植入静脉输液港并发症的临床研究Clinical Application on Complications of Implantable Venous-Access Port through Different Routes[J]. 临床医学进展, 2022, 12(01): 223-228. https://doi.org/10.12677/ACM.2022.121034