摘要
目的分析经右颈静脉的完全植入式输注泵(TIAP)各手术操作细节与术后并发症的相关性。方法回顾性收集2012年3月-2017年3月于首都医科大学附属北京世纪坛医院行右颈内静脉TIAP植入术的749例患者的临床资料,分析具体手术方式与导管相关感染、管路位置异常、管路堵塞等术后并发症的相关性。结果术后并发症TIAP导管相关感染共9例;导管位置异常行二次手术调整共6例;管路堵塞共9例;另有导管断裂或脱落4例、体件翻转2例及皮肤破溃1例。Cox回归分析提示,术后感染危险因素包括术中B超定位、手术时间延长。术中X线定位者,其导管末端距气管隆突的平均距离是(4.64±0.43)cm,而未行术中X线定位者的平均距离是(3.44±1.12)cm,2组比较差异有统计学意义(P<0.05),且均小于指南要求的理想值6 cm。Cox回归分析提示,管路堵塞危险因素包括导管转角锐利、术中检验无回抽血。结论适当的手术操作可能减少经右颈内静脉输注泵植入的术后并发症风险。
Objective To analyze the correlation between surgical procedures and postoperative complication on totally implantable access port(TIAP)via the right jugular vein.Methods A total of 749 patients who received TIAP via the right jugular vein at Beijing Shijitan Hospital from March 2012 to March 2017 were included in the current retrospec?tive study.The correlation between surgical procedures,catheter-related infection,abnormal catheter position and duct blockage and other post-operative complications were analyzed.Results There were 9 patients with TIAP-related infection,6 patients who underwent secondary operation for abnormal catheter position,and 9 patients with duct blockage.Furthermore,there were also 4 cases of duct break,2 cases of pump body reversal and 1 case of skin ulceration.According to Cox regression analysis,the post-operational infection risks were B-type ultrasonography fixed position during operation and extended operation time.The average distance of the catheter over the carina was(4.64±0.43)cm in patients using X-ray for fixed position during surgery,which was statistically different from the average distance(3.44±1.12)cm of those without fixed position through X ray during surgery(P<0.05).Both average distances were less than 6 cm,the optical value required in the guidelines.The risk factors of catheter blockage were sharp angles of the catheter turn-back and no drawn blood.Conclusions Appropriate operation procedures can reduce the risk of post-operative complication after using TIAP via the right jugular vein.
作者
李天雄
张能维
LI Tianxiong;ZHANG Nengwei(Department of General Surgery,Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038,China)
出处
《徐州医科大学学报》
CAS
2019年第10期758-762,共5页
Journal of Xuzhou Medical University
关键词
完全植入式输注泵
手术方式
术后并发症
totally implantable access port
surgical procedures
post-operative complication