经皮左锁骨下动脉导管药盒系统置入术的中远期并发症及处理

Percutaneous Port catheter System Implantation via Left Subclavian Artery: Middle term and Long term Complications and Their Management

目的 探讨经皮左锁骨下动脉导管药盒系统 (PCS)置入术的中远期并发症的原因及处理方法。材料与方法 2 5 6例胸、腹部和盆腔等部位的晚期恶性肿瘤患者 ,行经皮左锁骨下动脉穿刺PCS置入术。术后隔 3 0～ 40天行经PCS灌注化疗或碘油化疗乳剂栓塞术。随访 2个月～ 3年 ,平均 11.5个月。结果 使用时间为 1～ 3 6个月 ,平均为 10 .5个月。PCS置入术 3 0天后 ,5 3例发生与PCS有关的并发症 ,发生率为 2 0 .7%。主要包括 :除主动脉置管者外 ,留置管移位率为 7.8% ( 16/2 0 5 ) ,靶动脉闭塞占 7.4%( 19/2 5 6)。二者经原途径更换新的留置导管和调整到满意位置 16例 ,拔除PCS 8例 ,其余 11例未作处理。留置导管阻塞占 2 .0 %( 5 /2 5 6) ,经加压注入尿激酶溶液PCS再通 2例。药盒囊腔内积血占 2 .0 % ( 5 /2 5 6) ,经局部穿刺抽吸或切开引流治疗后痊愈。皮肤坏死占 3 .1% ( 8/2 5 6) ,均拔除PCS。结论 经皮左锁骨下动脉PCS置入术的中远期并发症 ,发生率较低 ,大多数经适当处理 ,不影响PCS的正常使用。

Objective To study the causes of middle and long term complications related to percutaneous port catheter system (PCS) implantation via left subclavian artery (SCA), and their management.Materials and Methods Percutaneous PCS implantation via SCA was successfully performed in 256 patients with thoracic, abdominal or pelvic advanced malignant tumors. After the procedure, chemotherapy or chemoembolization with the emulsion of lipiodol and anticancer agents via PCS was carried out at an interval of 30～40 days. The following up period ranged from 2 to 36 months with the median of 11.5 months.Results The service interval of PCS was 1～36 months (median 11.5 months). Late complications (>30 days after operation) occurred in 53 patients (20.7%), including indwelling catheter tip dislocation (n=16, 7.8%), obliteration of target artery (n=19, 7.4%), hematoma of device pocket (n=5, 2.0%), skin necrosis over port (n=8, 3.1%). A new indwelling catheter was satisfactorily replaced and adjusted by reintervention via the same access in 16 patients with migrated catheter (n=12) and occlusion of target artery (n=4). The blocked catheter was recanalized by thrombolytic therapy in 2 patients. Hematoma of device pocket was cured by puncture aspiration or incision drainage in all 5 patients. The PCSs were removed in all 8 patients with skin necrosis, and in 8 patients with migrated catheter (n=2) or occlusive target artery (n=6). In the other 14 patients, PCSs were reserved in situ and rendered useless.Conclusion Late complications related to percutaneous PCS implantation via left SCA are low, and the PCSs can maintain normal service after appropriate management in most cases.